MEDICARE: BIANCA LAUREN RUCKER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700572906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA LAUREN RUCKER

Provider Business Mailing Address
First Line	:	325 E UNIVERSITY BLVD APT 170
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-7071
Country	:	US
Telephone Number	:	321-662-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	391 COMMERCE PKWY STE 220
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4209
Country	:	US
Telephone Number	:	321-258-9537
Fax Number	:	321-541-9135

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

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/22/2023

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Directions to “ BIANCA LAUREN RUCKER ” Practice Location

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