Provider Demographics
NPI:1083095566
Name:RUGANI, KELLI ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:RUGANI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 TAMALPAIS AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3940
Mailing Address - Country:US
Mailing Address - Phone:415-250-6809
Mailing Address - Fax:
Practice Address - Street 1:790 TAMALPAIS AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3940
Practice Address - Country:US
Practice Address - Phone:415-250-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2014034755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2014034755OtherFAMILY NURSE PRACTITIONER CERTIFICATION