Provider Demographics
NPI:1730741760
Name:BERRY, RUTH NAOMI (APRN)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:NAOMI
Last Name:BERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:850-767-4777
Mailing Address - Fax:850-249-0971
Practice Address - Street 1:12216 PANAMA CITY BEACH PKWY STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2728
Practice Address - Country:US
Practice Address - Phone:850-249-0917
Practice Address - Fax:850-249-0971
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9344387163WP0200X
FL11002907363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104627900Medicaid