Provider Demographics
NPI:1356821953
Name:RUUD, TAYLOR ISAAC
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ISAAC
Last Name:RUUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 VENICE WAY APT 3106
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9626
Mailing Address - Country:US
Mailing Address - Phone:435-704-4818
Mailing Address - Fax:
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2019-05-03
Deactivation Date:2019-03-11
Deactivation Code:
Reactivation Date:2019-03-18
Provider Licenses
StateLicense IDTaxonomies
FL11001894367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered