Provider Demographics
NPI:1912080714
Name:RUBEN, WANDA MILAGROS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:MILAGROS
Last Name:RUBEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:MILAGROS
Other - Last Name:ENCARNACION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15717 BEACHCOMBER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3713
Mailing Address - Country:US
Mailing Address - Phone:239-267-9169
Mailing Address - Fax:239-277-1552
Practice Address - Street 1:2040 COLLIER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8124
Practice Address - Country:US
Practice Address - Phone:239-277-9151
Practice Address - Fax:239-277-1552
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9226484OtherFAMILY NURSE PRACTITIONER