Provider Demographics
NPI:1801548540
Name:RUCKER, JAMEL AMELE (BS, RRT)
Entity type:Individual
Prefix:MR
First Name:JAMEL
Middle Name:AMELE
Last Name:RUCKER
Suffix:
Gender:M
Credentials:BS, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 NEW BROAD CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7327
Mailing Address - Country:US
Mailing Address - Phone:407-457-0153
Mailing Address - Fax:
Practice Address - Street 1:4000 NEW BROAD CIR APT 204
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7327
Practice Address - Country:US
Practice Address - Phone:407-457-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT77562279H0200X, 227900000X
251E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies