Provider Demographics
NPI:1437978772
Name:COBARRUBIA, JADE ELISA (RN)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:ELISA
Last Name:COBARRUBIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LAKE MARY BLVD # 3076
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5925
Mailing Address - Country:US
Mailing Address - Phone:689-300-6321
Mailing Address - Fax:
Practice Address - Street 1:250 W LAKE MARY BLVD # 3076
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5925
Practice Address - Country:US
Practice Address - Phone:689-300-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9377411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse