MEDICARE: SANDRA RUA

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	363LF0000X	Family Nurse Practitioner	11018981	FL

General Provider Information

NPI Number	:	1962026278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RUA

Provider Business Mailing Address
First Line	:	21014 SW 125TH COURT RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-5754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11272 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4203
Country	:	US
Telephone Number	:	786-424-1584
Fax Number	:	786-478-2267

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	08/08/2023

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Directions to “ SANDRA RUA ” Practice Location

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