Provider Demographics
NPI:1851012421
Name:RUBOLINO, JILL (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:RUBOLINO
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 1:5137 CONSERVATION CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8778
Mailing Address - Country:US
Mailing Address - Phone:815-531-9560
Mailing Address - Fax:
Practice Address - Street 1:730 N NEW WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4247
Practice Address - Country:US
Practice Address - Phone:850-696-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073616363LF0000X
FLAPRN11024103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily