Provider Demographics
NPI:1528022639
Name:RAISON, RUTH L (CNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:RAISON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SW1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0900
Mailing Address - Country:US
Mailing Address - Phone:352-732-6599
Mailing Address - Fax:352-732-4816
Practice Address - Street 1:1025 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0900
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:352-732-4816
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN120956363LF0000X
FLARNP1913902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004721600Medicaid
OH2019845Medicaid
FL004721600Medicaid