Healthcare Provider Details

I. General information

NPI: 1215873237
Provider Name (Legal Business Name): RUTH RENAE LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

IV. Provider business mailing address

5 WINDSOR WAY
CRAWFORDVILLE FL
32327-1374
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-0191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11041604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: