Healthcare Provider Details

I. General information

NPI: 1851071351
Provider Name (Legal Business Name): ALEXANDRIA ANNE RUTISHAUSER DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-2135
  • Fax:
Mailing address:
  • Phone: 321-841-7856
  • Fax: 321-843-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN11027613
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN1027613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: