Healthcare Provider Details

I. General information

NPI: 1174259857
Provider Name (Legal Business Name): ASHLEY RINUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

224 TAYLOR BAY LN
BRANDON FL
33510-2436
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax:
Mailing address:
  • Phone: 904-652-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11020822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: