Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 15296 | FL |
NPI | 1184005027 |
---|---|
Provider Name | Dr. Amanda Cruz-Deweese |
First Address | Jacksonville, FL 32224-7911 |
Second Address | Jacksonville, FL 32207-8329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 09/07/2021 |