Provider Demographics
NPI:1356516827
Name:CARDONA RUELLE, IVETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:CARDONA RUELLE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 WEBB ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-888-8215
Mailing Address - Fax:813-885-5398
Practice Address - Street 1:5901 WEBB ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-888-8215
Practice Address - Fax:813-885-5398
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN650208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN650OtherMEDICAL LICENSE