Provider Demographics
NPI:1588699672
Name:BROUWER, RUTH E (PA-C)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:E
Last Name:BROUWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST
Mailing Address - Street 2:201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9192
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:2415 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2618
Practice Address - Country:US
Practice Address - Phone:352-732-5365
Practice Address - Fax:352-732-5372
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004469363A00000X
FLPA3128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292526500Medicaid
FLE8822YMedicare PIN
FLP76390Medicare UPIN