Provider Demographics
NPI:1801447032
Name:RUBY, TRISHA (FNP-C)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:RUBY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 LYRA DR STE 364
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2319
Mailing Address - Country:US
Mailing Address - Phone:314-996-9641
Mailing Address - Fax:
Practice Address - Street 1:3062 KINGSDALE CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2020
Practice Address - Country:US
Practice Address - Phone:614-484-1940
Practice Address - Fax:614-484-1941
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0491440Medicaid