MEDICARE: RUTH NAOMI BERRY 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
1	163WP0200X	Pediatric Registered Nurse	9344387	FL
2	363LP0200X	Pediatric Nurse Practitioner	11002907	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730741760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH NAOMI BERRY APRN

Provider Business Mailing Address
First Line	:	900 S PINE ISLAND RD STE 800
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3923
Country	:	US
Telephone Number	:	850-767-4777
Fax Number	:	850-249-0971

Provider Business Practice Location Address
First Line	:	12216 PANAMA CITY BEACH PKWY STE B
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2728
Country	:	US
Telephone Number	:	850-249-0917
Fax Number	:	850-249-0971

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

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	04/05/2021

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Directions to “ RUTH NAOMI BERRY APRN” Practice Location

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