Healthcare Provider Details

I. General information

NPI: 1124856190
Provider Name (Legal Business Name): GERARDO JAVIER RUZ BAUDINO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9685 LAKE NONA VILLAGE PL STE 103
ORLANDO FL
32827-7321
US

IV. Provider business mailing address

7261 SHERIDAN ST STE 340
HOLLYWOOD FL
33024-2726
US

V. Phone/Fax

Practice location:
  • Phone: 407-557-8160
  • Fax: 407-557-8159
Mailing address:
  • Phone: 954-561-6222
  • Fax: 954-990-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11034205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: