MEDICARE: RUTH STAYTE

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	163W00000X	Registered Nurse	9443642	FL
2	363LF0000X	Family Nurse Practitioner	11046120	FL

General Provider Information

NPI Number	:	1154269173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH STAYTE

Provider Business Mailing Address
First Line	:	4645 W SAN JOSE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-6542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 W SAN JOSE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-6542
Country	:	US
Telephone Number	:	832-875-8343
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ RUTH STAYTE ” Practice Location

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