Provider Demographics
NPI:1306542113
Name:RUGGIERE, KRISTIN LEE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:RUGGIERE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6669 PAUL MAR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3939
Mailing Address - Country:US
Mailing Address - Phone:561-436-1018
Mailing Address - Fax:
Practice Address - Street 1:1232 W INDIANTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3905
Practice Address - Country:US
Practice Address - Phone:561-277-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily