Healthcare Provider Details

I. General information

NPI: 1316811904
Provider Name (Legal Business Name): GLENDA GARCIA RUANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 PATRICK ST STE 206
KISSIMMEE FL
34741-5612
US

IV. Provider business mailing address

722 PATRICK ST STE 206
KISSIMMEE FL
34741-5612
US

V. Phone/Fax

Practice location:
  • Phone: 321-946-9585
  • Fax: 201-474-0468
Mailing address:
  • Phone: 321-946-9585
  • Fax: 201-474-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: