Provider Demographics
NPI:1164550356
Name:NETTLETON, RUTHANN YODER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RUTHANN
Middle Name:YODER
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3225
Mailing Address - Country:US
Mailing Address - Phone:352-318-0039
Mailing Address - Fax:
Practice Address - Street 1:1121 NW 64TH TER
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4243
Practice Address - Country:US
Practice Address - Phone:352-331-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9102568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04863Medicare UPIN
U1896WMedicare ID - Type Unspecified