Provider Demographics
NPI:1841772852
Name:RUCKMAN, DARON DALE (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:DARON
Middle Name:DALE
Last Name:RUCKMAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 E KELTON LN UNIT 1243
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1010
Mailing Address - Country:US
Mailing Address - Phone:816-550-4162
Mailing Address - Fax:
Practice Address - Street 1:3805 E BELL RD STE 2100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2180
Practice Address - Country:US
Practice Address - Phone:602-404-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily