MEDICARE: ELIZABETH RUELKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	TRN45045	FL

General Provider Information

NPI Number	:	1053253690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RUELKE

Provider Business Mailing Address
First Line	:	580 W 8TH ST, TOWER II, 6TH FLOOR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6533
Country	:	US
Telephone Number	:	904-244-9905
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6533
Country	:	US
Telephone Number	:	904-244-9905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	05/18/2026

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