Provider Demographics
NPI:1912768920
Name:RUBIN, JESSICA CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTINA
Last Name:RUBIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CHRISTINA
Other - Last Name:NICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1320 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6534
Mailing Address - Country:US
Mailing Address - Phone:321-662-2071
Mailing Address - Fax:
Practice Address - Street 1:1320 S GRANT ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6534
Practice Address - Country:US
Practice Address - Phone:321-662-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner