Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME84358 | FL |
N | 111NI0900X | Internist | ME84358 | FL |
Y | 207RR0500X | Rheumatology | ME84358 | FL |
NPI | 1043322019 |
---|---|
Provider Name | Dr. Laura Mcilwain Cruse |
First Address | Tampa, FL 33613-3923 |
Second Address | Tampa, FL 33613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I17048 | (02) |