Healthcare Provider Details

I. General information

NPI: 1154887362
Provider Name (Legal Business Name): RUTH JOAN RAGORO VODOPIVC AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

IV. Provider business mailing address

27380 BONTERRA LOOP APT 406
WESLEY CHAPEL FL
33544-5158
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-8111
  • Fax:
Mailing address:
  • Phone: 734-516-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9406881
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9406881
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9406881
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9406881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: