Healthcare Provider Details

I. General information

NPI: 1750706974
Provider Name (Legal Business Name): TINA V. KUBA A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W BROAD ST
COLUMBUS OH
43223-1297
US

IV. Provider business mailing address

2200 W BROAD ST
COLUMBUS OH
43223-1297
US

V. Phone/Fax

Practice location:
  • Phone: 614-752-0333
  • Fax:
Mailing address:
  • Phone: 614-752-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.358725-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA-15351-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: