Provider Demographics
NPI:1871041590
Name:RURI, KATIE GRACE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:GRACE
Last Name:RURI
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 REBECCA LN STE 107
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8350
Mailing Address - Country:US
Mailing Address - Phone:386-775-5299
Mailing Address - Fax:386-218-0037
Practice Address - Street 1:2725 REBECCA LN STE 107
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8350
Practice Address - Country:US
Practice Address - Phone:867-755-2993
Practice Address - Fax:386-218-0037
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9422109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health