Provider Demographics
NPI:1881691889
Name:LUBISCH, NINA B (ARNP)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:B
Last Name:LUBISCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:B
Other - Last Name:LUBISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1600 S ANDREWS AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC ADMINISTRATION
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-712-3984
Mailing Address - Fax:954-468-4012
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC ADMINISTRATION
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-712-3984
Practice Address - Fax:954-468-4012
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1556452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily