Provider Demographics
NPI:1871751297
Name:CRUZ, AMY LARAE (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LARAE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LARAE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C230
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1297
Mailing Address - Country:US
Mailing Address - Phone:801-682-1032
Mailing Address - Fax:801-991-4907
Practice Address - Street 1:3838 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-269-0231
Practice Address - Fax:801-269-0304
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3409938900363LF0000X
UT3409934405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily