Healthcare Provider Details

I. General information

NPI: 1356821953
Provider Name (Legal Business Name): TAYLOR ISAAC RUUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date: 03/11/2019
Reactivation Date: 03/18/2019

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

7060 VENICE WAY APT 3106
NAPLES FL
34119-9626
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-5000
  • Fax:
Mailing address:
  • Phone: 435-704-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11001894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: