Provider Demographics
NPI:1265150924
Name:RUBIS, EVGENIYA VICTOROVNA (APRN)
Entity type:Individual
Prefix:
First Name:EVGENIYA
Middle Name:VICTOROVNA
Last Name:RUBIS
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 1:250 PALM COAST PKWY NE # 121-607
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8224
Mailing Address - Country:US
Mailing Address - Phone:386-225-5561
Mailing Address - Fax:
Practice Address - Street 1:250 PALM COAST PKWY NE # 121-607
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8224
Practice Address - Country:US
Practice Address - Phone:386-225-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily