1487468906 NPI number — MRS. BOBBIE KRISTENA RUIZ FNP-BC BSN RN

Table of content: MRS. BOBBIE KRISTENA RUIZ FNP-BC BSN RN (NPI 1487468906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487468906 NPI number — MRS. BOBBIE KRISTENA RUIZ FNP-BC BSN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ
Provider First Name:
BOBBIE
Provider Middle Name:
KRISTENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC BSN RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487468906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 SPRING ST NW APT 29M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-5148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-278-5489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 PACES FERRY RD SE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-4099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-813-3775
Provider Business Practice Location Address Fax Number:
770-626-3791
Provider Enumeration Date:
02/04/2025

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: 363L00000X , with the licence number:  RN300400 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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