Healthcare Provider Details

I. General information

NPI: 1629192919
Provider Name (Legal Business Name): RUDD FAMILY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 COLLEGE DR
GRACEVILLE FL
32440-1307
US

IV. Provider business mailing address

4369 PEANUT RD
COTTONDALE FL
32431-6557
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-3964
  • Fax: 850-263-3966
Mailing address:
  • Phone: 850-263-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberARNP3306442
License Number StateFL

VIII. Authorized Official

Name: MS. CYNTHIA JANE RUDD
Title or Position: PRESIDENT
Credential: ARNP
Phone: 850-263-3964