Healthcare Provider Details

I. General information

NPI: 1104695071
Provider Name (Legal Business Name): RUTH JANICE GIMENEZ APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 OLD HICKORY TREE RD STE 107
SAINT CLOUD FL
34772-8901
US

IV. Provider business mailing address

2090 OLD HICKORY TREE RD STE 107
SAINT CLOUD FL
34772-8901
US

V. Phone/Fax

Practice location:
  • Phone: 689-588-5588
  • Fax:
Mailing address:
  • Phone: 689-588-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9304243
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: