Provider Demographics
NPI:1679289540
Name:CRUZ, JENMARK ADAN (APRN)
Entity type:Individual
Prefix:
First Name:JENMARK
Middle Name:ADAN
Last Name:CRUZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ANDOVER LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1639
Mailing Address - Country:US
Mailing Address - Phone:806-333-8432
Mailing Address - Fax:
Practice Address - Street 1:1411 DENVER AVE
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4809
Practice Address - Country:US
Practice Address - Phone:806-244-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily