MEDICARE: RUTH SERVIUS FNP

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	F02260358	FL

General Provider Information

NPI Number	:	1720930951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH SERVIUS FNP

Provider Business Mailing Address
First Line	:	1105 VALENCIA AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6133
Country	:	US
Telephone Number	:	954-822-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 VALENCIA AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6133
Country	:	US
Telephone Number	:	954-822-4479
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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