Healthcare Provider Details

I. General information

NPI: 1235155409
Provider Name (Legal Business Name): RUTHIE JOHNSON SIRMANS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 W CENTRAL BLVD
ORLANDO FL
32805-1809
US

IV. Provider business mailing address

1703 TIVERTON ST
WINTER SPRINGS FL
32708-6123
US

V. Phone/Fax

Practice location:
  • Phone: 407-836-2542
  • Fax:
Mailing address:
  • Phone: 407-359-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number3129082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: