Healthcare Provider Details

I. General information

NPI: 1114836947
Provider Name (Legal Business Name): AMBER RUISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 M L KING DR
MACCLENNY FL
32063-2351
US

IV. Provider business mailing address

374 M L KING DR
MACCLENNY FL
32063-2351
US

V. Phone/Fax

Practice location:
  • Phone: 904-310-8292
  • Fax:
Mailing address:
  • Phone: 904-310-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number242130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: