Provider Demographics
NPI:1649301383
Name:RUBRIGHT, REBECCA JO (AP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:RUBRIGHT
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3912
Mailing Address - Country:US
Mailing Address - Phone:813-892-6909
Mailing Address - Fax:
Practice Address - Street 1:4203 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3912
Practice Address - Country:US
Practice Address - Phone:813-892-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0987OtherBLUE CROSS BLUE SHIELD ID