1912080714 NPI number — MRS. WANDA MILAGROS RUBEN ARNP

Table of content: MRS. WANDA MILAGROS RUBEN ARNP (NPI 1912080714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912080714 NPI number — MRS. WANDA MILAGROS RUBEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBEN
Provider First Name:
WANDA
Provider Middle Name:
MILAGROS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENCARNACION
Provider Other First Name:
WANDA
Provider Other Middle Name:
MILAGROS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912080714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15717 BEACHCOMBER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-267-9169
Provider Business Mailing Address Fax Number:
239-277-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 COLLIER AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-277-9151
Provider Business Practice Location Address Fax Number:
239-277-1552
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9226484 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ARNP9226484 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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