Healthcare Provider Details

I. General information

NPI: 1114362829
Provider Name (Legal Business Name): RUBY PEARL GATES ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIRCLE
TAMPA FL
33606
US

IV. Provider business mailing address

521 PINELLAS BAYWAY SOUTH UNIT 402
TIERRA VERDE FL
33715-1999
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone: 813-844-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9172734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: