Provider Demographics
NPI:1013399898
Name:RINALD, ROBERTA JUKES (NP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JUKES
Last Name:RINALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1807
Mailing Address - Country:US
Mailing Address - Phone:361-888-6782
Mailing Address - Fax:361-888-6788
Practice Address - Street 1:2502 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1807
Practice Address - Country:US
Practice Address - Phone:361-888-6782
Practice Address - Fax:361-888-6788
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347969301Medicaid
TX1932154101Medicaid