Provider Demographics
NPI:1801112792
Name:RUBY, SARA A (ACNP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:A
Last Name:RUBY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:BRASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 OFFICE PARK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1585
Mailing Address - Country:US
Mailing Address - Phone:513-893-5864
Mailing Address - Fax:513-893-5865
Practice Address - Street 1:10 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1585
Practice Address - Country:US
Practice Address - Phone:513-893-5864
Practice Address - Fax:513-893-5865
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318517163WC0200X
OHCOA.11528-NP363L00000X
OHCOA11528-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3087538Medicaid
OH3087538Medicaid