Healthcare Provider Details

I. General information

NPI: 1912798505
Provider Name (Legal Business Name): JOHANNA IVETTE RUIZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 PINES BLVD STE 150
PEMBROKE PINES FL
33024-6400
US

IV. Provider business mailing address

701 BRICKELL KEY BLVD APT 2302
MIAMI FL
33131-2682
US

V. Phone/Fax

Practice location:
  • Phone: 954-872-0555
  • Fax: 954-256-6057
Mailing address:
  • Phone: 305-987-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11039090
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11039090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: