Provider Demographics
NPI:1326513136
Name:RUBIO, SARA CHRISTINA (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:CHRISTINA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N STOCKTON HILL RD STE G
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4100
Mailing Address - Country:US
Mailing Address - Phone:928-718-2225
Mailing Address - Fax:928-718-2226
Practice Address - Street 1:2302 N STOCKTON HILL RD STE G
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4100
Practice Address - Country:US
Practice Address - Phone:928-718-2225
Practice Address - Fax:928-718-2226
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127360163W00000X
AZ218450363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZ218450OtherAGACNP-BC LICENSE
AZ218450OtherAGACNP-BC LICENSE