Provider Demographics
NPI:1255357018
Name:RUBIN, RITA L (ARNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:L
Last Name:RUBIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BEACH DR SE
Mailing Address - Street 2:1512
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3963
Mailing Address - Country:US
Mailing Address - Phone:352-359-5975
Mailing Address - Fax:
Practice Address - Street 1:6015 POINTE WEST BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5525
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-761-9703
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2139052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305649000Medicaid
FLS67683Medicare UPIN
FLE1606XMedicare ID - Type Unspecified