Healthcare Provider Details

I. General information

NPI: 1831365162
Provider Name (Legal Business Name): RUTH WOODS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10749 BAHIA DR
JACKSONVILLE FL
32246-8829
US

IV. Provider business mailing address

10749 BAHIA DR
JACKSONVILLE FL
32246-8829
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-2434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: