MEDICARE: NATALIE O RUGE LMFT

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	106H00000X	Marriage & Family Therapist	MT2419	FL
2	106H00000X	Marriage & Family Therapist	IMF 51455	CA

General Provider Information

NPI Number	:	1730375619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE O RUGE LMFT

Provider Business Mailing Address
First Line	:	7545 CENTURION PKWY STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4118
Country	:	US
Telephone Number	:	904-651-5102
Fax Number	:	773-897-1726

Provider Business Practice Location Address
First Line	:	7545 CENTURION PKWY STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4118
Country	:	US
Telephone Number	:	904-651-5102
Fax Number	:	773-897-1726

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	12/13/2023

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