Provider Demographics
NPI:1447810825
Name:RUDD, ALLISON NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:RUDD
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 1:9745 SW EASTBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2429
Mailing Address - Country:US
Mailing Address - Phone:772-341-5709
Mailing Address - Fax:
Practice Address - Street 1:2220 SE OCEAN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-220-3339
Practice Address - Fax:772-286-2635
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily