Healthcare Provider Details

I. General information

NPI: 1881844942
Provider Name (Legal Business Name): RUTH C WILSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH CONSTANCE GREMILLION RN BSN

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S WOODS DR
ROCKLEDGE FL
32955-3262
US

IV. Provider business mailing address

134 S WOODS DR
ROCKLEDGE FL
32955-3262
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-3066
  • Fax: 321-636-2545
Mailing address:
  • Phone: 321-636-3066
  • Fax: 321-636-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP898842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: