Healthcare Provider Details

I. General information

NPI: 1437721941
Provider Name (Legal Business Name): JAVIER GARCIA RUIZ PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 09/23/2023
Reactivation Date: 11/02/2023

III. Provider practice location address

4800 NE 20TH TER STE 101
FORT LAUDERDALE FL
33308-4510
US

IV. Provider business mailing address

4800 NE 20TH TER STE 101
FORT LAUDERDALE FL
33308-4510
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-2126
  • Fax: 954-566-2150
Mailing address:
  • Phone: 954-566-2160
  • Fax: 954-566-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11028408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11028408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: