Provider Demographics
NPI:1629047287
Name:WERMONT, RUTH ELLEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELLEN
Last Name:WERMONT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:514 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5108
Mailing Address - Country:US
Mailing Address - Phone:772-871-5900
Mailing Address - Fax:772-871-1197
Practice Address - Street 1:538 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5108
Practice Address - Country:US
Practice Address - Phone:772-871-5900
Practice Address - Fax:772-871-1197
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP41047Medicare UPIN