Provider Demographics
NPI:1346037397
Name:OSSI, RUWAIDAH
Entity type:Individual
Prefix:
First Name:RUWAIDAH
Middle Name:
Last Name:OSSI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 ROBERTS LAKE PL FL 33614
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4374
Mailing Address - Country:US
Mailing Address - Phone:904-982-0423
Mailing Address - Fax:904-982-0423
Practice Address - Street 1:2806 ROBERTS LAKE PL FL 33614
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4374
Practice Address - Country:US
Practice Address - Phone:904-982-0423
Practice Address - Fax:904-982-0423
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL24000454321311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home