Provider Demographics
NPI:1780176354
Name:RUIZ, SARAH (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 PINE MARSH LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7406
Mailing Address - Country:US
Mailing Address - Phone:321-278-4300
Mailing Address - Fax:
Practice Address - Street 1:1532 PINE MARSH LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7406
Practice Address - Country:US
Practice Address - Phone:321-278-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5198481164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse