Provider Demographics
NPI:1326587171
Name:JOSEPH, RUBY (APRN)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:JOSEPH
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 1:11213 VIA ANDIAMO
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6030
Mailing Address - Country:US
Mailing Address - Phone:786-395-9949
Mailing Address - Fax:
Practice Address - Street 1:2415 N ORANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-303-1812
Practice Address - Fax:407-303-1815
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9243251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily