Healthcare Provider Details

I. General information

NPI: 1194484519
Provider Name (Legal Business Name): STEPHANIE RUAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE STE 405
PLANTATION FL
33324-1883
US

IV. Provider business mailing address

201 NW 82ND AVE STE 405
PLANTATION FL
33324-1883
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: