Healthcare Provider Details

I. General information

NPI: 1326587171
Provider Name (Legal Business Name): RUBY JOSEPH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 200
ORLANDO FL
32804-5505
US

IV. Provider business mailing address

11213 VIA ANDIAMO
WINDERMERE FL
34786-6030
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1812
  • Fax: 407-303-1815
Mailing address:
  • Phone: 786-395-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9243251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: