Provider Demographics
NPI:1144232851
Name:RUBENBERG, LISA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:RUBENBERG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 LAS FLORES DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2366
Mailing Address - Country:US
Mailing Address - Phone:561-573-6477
Mailing Address - Fax:
Practice Address - Street 1:6521 LAS FLORES DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2366
Practice Address - Country:US
Practice Address - Phone:561-573-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9173478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3670OtherBCBS OF FLORIDA
FLG3670OtherBCBS OF FLORIDA