Healthcare Provider Details

I. General information

NPI: 1124692421
Provider Name (Legal Business Name): FATIMA XIOMARA RUIZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SEBRING SQ
SEBRING FL
33870-1622
US

IV. Provider business mailing address

5901 WEBB RD
TAMPA FL
33615-3219
US

V. Phone/Fax

Practice location:
  • Phone: 863-658-5066
  • Fax: 863-340-8792
Mailing address:
  • Phone: 813-888-8215
  • Fax: 813-885-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: