Provider Demographics
NPI:1114487089
Name:TOBILLO, RUBEN AQUINO JR (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:AQUINO
Last Name:TOBILLO
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7910
Mailing Address - Country:US
Mailing Address - Phone:407-452-7447
Mailing Address - Fax:
Practice Address - Street 1:2743 NORTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7910
Practice Address - Country:US
Practice Address - Phone:407-452-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2720122363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health