Provider Demographics
NPI:1447884473
Name:RUTHERFORD, JOY (APRN)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:RUTHERFORD
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 1:234 WILLARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7984
Mailing Address - Country:US
Mailing Address - Phone:321-631-9014
Mailing Address - Fax:321-631-8010
Practice Address - Street 1:234 WILLARD ST STE A
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7984
Practice Address - Country:US
Practice Address - Phone:321-631-9014
Practice Address - Fax:321-631-8010
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2499932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily