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General NPI Number Information
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NPI Number | 1285278226
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Entity Type | Individual
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Provider Name | RUTH AMISE EXANTUS APRN
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Gender | Female
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Dates
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Enumeration Date | 11/02/2019
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Last Update Date | 11/02/2019
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Provider Practice Location Address
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Address Line | 250 2ND ST E
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City | BRADENTON
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State | FL
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Zip | 34208-1029
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Country | US
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Telephone | 941-747-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 13TH AVE E
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City | PALMETTO
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State | FL
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Zip | 34221-4150
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Country | US
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Telephone | 941-726-4925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11004155
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License Number State | FL
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