Healthcare Provider Details

I. General information

NPI: 1265987481
Provider Name (Legal Business Name): GIANETTE RUVALCABA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 79TH STREET CSWY STE 120
NORTH BAY VILLAGE FL
33141-4197
US

IV. Provider business mailing address

1700 79TH STREET CSWY STE 120
NORTH BAY VILLAGE FL
33141-4197
US

V. Phone/Fax

Practice location:
  • Phone: 833-240-9966
  • Fax: 305-709-1320
Mailing address:
  • Phone: 305-726-2177
  • Fax: 305-726-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9328207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: