Provider Demographics
NPI:1619415734
Name:GALLAGHER, RUTH (NP-C, PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP-C, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-3615
Mailing Address - Country:US
Mailing Address - Phone:727-251-4102
Mailing Address - Fax:
Practice Address - Street 1:602 72ND AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-3615
Practice Address - Country:US
Practice Address - Phone:727-251-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1605962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily