Healthcare Provider Details

I. General information

NPI: 1316302789
Provider Name (Legal Business Name): DANIEL PINO RUIZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 FOREST HILL BLVD STE 3
LAKE CLARKE SHORES FL
33406-6077
US

IV. Provider business mailing address

1511 FOREST HILL BLVD STE 3
LAKE CLARKE SHORES FL
33406-6077
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-3556
  • Fax: 561-967-5559
Mailing address:
  • Phone: 561-433-3556
  • Fax: 561-967-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9385406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: