Provider Demographics
NPI:1073909909
Name:ADAM, RUTH (AGACNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 MYSTIC POINTE DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4541
Mailing Address - Country:US
Mailing Address - Phone:786-314-3968
Mailing Address - Fax:
Practice Address - Street 1:3530 MYSTIC POINTE DR
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4541
Practice Address - Country:US
Practice Address - Phone:786-314-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9282664363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2014029055OtherAMERICAN NURSES CREDENTIALING CENTER