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NPI Code Detail

MEDICARE: RUTH KANGETHE APRN

MEDICARE: RUTH KANGETHE APRN
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
1363LF0000XFamily Nurse Practitioner11017116FL

General Provider Information

NPI Number : 1093475659
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH KANGETHE APRN
Provider Business Mailing Address
First Line : 325 CLYDE MORRIS BLVD
Second Line : STE 340
City : ORMOND BEACH
State : FL
Zip : 32174-3199
Country : US
Telephone Number : 386-615-8971
Fax Number :
Provider Business Practice Location Address
First Line : 325 CLYDE MORRIS BLVD STE 340
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-3199
Country : US
Telephone Number : 386-615-8971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2021
Last Update Date : 01/07/2022

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Directions to “ RUTH KANGETHE APRN” Practice Location

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