Provider Demographics
NPI:1730296773
Name:RUTIZER, LAURA MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:RUTIZER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:KANAMINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3033 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9413
Mailing Address - Country:US
Mailing Address - Phone:239-939-3939
Mailing Address - Fax:239-931-6114
Practice Address - Street 1:3033 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:239-931-6114
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2947792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305974000Medicaid
Q09999Medicare UPIN
FL305974000Medicaid