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Individual
KENDRA M RUCKMAN
Active
Individual
KENDRA M RUCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005799
GA
363A00000X
Physician Assistant
Primary
PA9106918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013210300
—
FL
01
—
9284904
AETNA
FL
01
—
GO616Y
FL MEDICARE
FL
01
—
P01165565
FL RR MEDICARE
FL
01
—
Y0E5E
FLORIDA BLUE (BCBS)
FL
Enumeration date
03/10/2010
Last updated
03/12/2020
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