Healthcare Provider Details

I. General information

NPI: 1255357018
Provider Name (Legal Business Name): RITA L RUBIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 POINTE WEST BLVD
BRADENTON FL
34209-5525
US

IV. Provider business mailing address

1 BEACH DR SE 1512
ST PETERSBURG FL
33701-3963
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax: 941-761-9703
Mailing address:
  • Phone: 352-359-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2139052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: