Healthcare Provider Details

I. General information

NPI: 1962026278
Provider Name (Legal Business Name): SANDRA RUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11272 SW 137TH AVE
MIAMI FL
33186-4203
US

IV. Provider business mailing address

21014 SW 125TH COURT RD
MIAMI FL
33177-5754
US

V. Phone/Fax

Practice location:
  • Phone: 786-424-1584
  • Fax: 786-478-2267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11018981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: