Healthcare Provider Details

I. General information

NPI: 1386918423
Provider Name (Legal Business Name): CELINA RUYSSERS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W COPELAND DR
ORLANDO FL
32806-2101
US

IV. Provider business mailing address

125 W COPELAND DR
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7090
  • Fax: 321-843-2267
Mailing address:
  • Phone: 321-841-7090
  • Fax: 321-843-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9106320
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: