Provider Demographics
NPI:1821503111
Name:RUTLEDGE, DEMETRIA LAVETTE (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:LAVETTE
Last Name:RUTLEDGE
Suffix:
Gender:
Credentials:APRN-C
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Other - First Name:
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Mailing Address - Street 1:13194 US HIGHWAY 301 S UNIT 228
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7410
Mailing Address - Country:US
Mailing Address - Phone:352-807-4857
Mailing Address - Fax:352-218-6045
Practice Address - Street 1:831 NW COUNCIL DR STE 125
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3794
Practice Address - Country:US
Practice Address - Phone:503-665-8176
Practice Address - Fax:503-665-8176
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95026940363LF0000X
FLAPRN9181104363LF0000X
TX1160779363LF0000X
VT101.0137529363LF0000X
OR10010881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101700500Medicaid