Basic Information
| Provider Information | |||||||||
| NPI: | 1588699672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROUWER | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 SE 17TH ST | ||||||||
| Address2: | 201 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344719192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526902171 | ||||||||
| FaxNumber: | 3526906954 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 SE 17TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344712618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527325365 | ||||||||
| FaxNumber: | 3527325372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 004469 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA3128 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 292526500 | 05 | FL | MEDICAID |