Healthcare Provider Details

I. General information

NPI: 1477418895
Provider Name (Legal Business Name): RUTH DACIUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N UNIVERSITY DR
HOLLYWOOD FL
33024-2222
US

IV. Provider business mailing address

1385 NE 128TH ST
NORTH MIAMI FL
33161-5105
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-6080
  • Fax:
Mailing address:
  • Phone: 786-678-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: