Provider Demographics
NPI:1437620143
Name:RUGGERIO, JOSEPH ANDRES (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDRES
Last Name:RUGGERIO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 VILLAGE CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3589
Mailing Address - Country:US
Mailing Address - Phone:843-497-6348
Mailing Address - Fax:843-236-1500
Practice Address - Street 1:199 VILLAGE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3589
Practice Address - Country:US
Practice Address - Phone:843-497-6348
Practice Address - Fax:843-236-1500
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily