Basic Information
| Provider Information | |||||||||
| NPI: | 1255357018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BEACH DR SE | ||||||||
| Address2: | 1512 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337013963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523595975 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6015 POINTE WEST BLVD | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342095525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417921404 | ||||||||
| FaxNumber: | 9417619703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP2139052 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 305649000 | 05 | FL | MEDICAID |