MEDICARE: LISA ANN RUBENBERG CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9173478	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G3670	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1144232851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN RUBENBERG CRNA

Provider Business Mailing Address
First Line	:	6521 LAS FLORES DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2366
Country	:	US
Telephone Number	:	561-573-6477
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 LAS FLORES DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2366
Country	:	US
Telephone Number	:	561-573-6477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	06/21/2008

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