Healthcare Provider Details

I. General information

NPI: 1669296240
Provider Name (Legal Business Name): RUTH CHERENFANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13731 METROPOLIS AVE
FORT MYERS FL
33912-7150
US

IV. Provider business mailing address

13731 METROPOLIS AVE
FORT MYERS FL
33912-7150
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-8555
  • Fax: 239-936-5611
Mailing address:
  • Phone: 239-936-8555
  • Fax: 239-936-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: