Provider Demographics
NPI:1578805602
Name:RUBOSKY, KRISTA MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:MARIE
Last Name:RUBOSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 SPRING VALLEY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9374
Mailing Address - Country:US
Mailing Address - Phone:218-438-0283
Mailing Address - Fax:513-823-3247
Practice Address - Street 1:6855 SPRING VALLEY DR STE 110
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9374
Practice Address - Country:US
Practice Address - Phone:218-438-0283
Practice Address - Fax:513-823-3247
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003759363A00000X
OH50.003759RX363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156697Medicaid