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General NPI Number Information
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NPI Number | 1437859865
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Entity Type | Individual
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Provider Name | RUBY ROSE MADARICO ETQUIBAL
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 502 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4720
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Country | US
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Telephone | 352-341-6195
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Fax |
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Provider Business Mailing Address
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Address Line | 2847 E MARCIA ST
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City | INVERNESS
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State | FL
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Zip | 34453-4503
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Country | US
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Telephone | 352-815-6524
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11025032
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License Number State | FL
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