Provider Demographics
NPI:1669092649
Name:KLINGMAN, RUTH A (AP 4008)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:A
Last Name:KLINGMAN
Suffix:
Gender:F
Credentials:AP 4008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKE ANNIE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-5548
Mailing Address - Country:US
Mailing Address - Phone:352-318-2107
Mailing Address - Fax:
Practice Address - Street 1:4 CONCORDE LN STE 2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-1655
Practice Address - Country:US
Practice Address - Phone:352-318-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist