MEDICARE: RUSLAN FEDKIV

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	363LP2300X	Primary Care Nurse Practitioner	11036129	FL

General Provider Information

NPI Number	:	1366300485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSLAN FEDKIV

Provider Business Mailing Address
First Line	:	18037 MAMBO DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-4113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18037 MAMBO DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-4113
Country	:	US
Telephone Number	:	917-309-6339
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ RUSLAN FEDKIV ” Practice Location

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