Basic Information
| Provider Information | |||||||||
| NPI: | 1326547357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDIC | ||||||||
| FirstName: | VALERIJA | ||||||||
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| Credential: | ARNP FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11513 MANSFIELD POINT DR | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335695904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138025221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 409 BAYSHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138445470 | ||||||||
| FaxNumber: | 8138441655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9325009 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | ARNP9325009 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.