MEDICARE: RUTH JANICE GIMENEZ APRN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9304243	FL
2	363LF0000X	Family Nurse Practitioner	APRN11030220	FL

General Provider Information

NPI Number	:	1104695071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH JANICE GIMENEZ APRN FNP-C

Provider Business Mailing Address
First Line	:	2090 OLD HICKORY TREE RD STE 107
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8901
Country	:	US
Telephone Number	:	689-588-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 OLD HICKORY TREE RD STE 107
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8901
Country	:	US
Telephone Number	:	689-588-5588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	10/02/2025

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