Healthcare Provider Details

I. General information

NPI: 1336065929
Provider Name (Legal Business Name): RUBY LIZA ROLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EMERSON ST
SOUTH BOSTON MA
02127-1415
US

IV. Provider business mailing address

2315 CENTRE ST APT 1
WEST ROXBURY MA
02132-5101
US

V. Phone/Fax

Practice location:
  • Phone: 617-717-4516
  • Fax:
Mailing address:
  • Phone: 617-717-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2309224
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: