Provider Demographics
NPI:1043387731
Name:JONES, GINA G (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:G
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIA
Other - Last Name:GUILLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:728 JOHNS WELL CT
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1729
Mailing Address - Country:US
Mailing Address - Phone:386-547-0975
Mailing Address - Fax:254-267-1049
Practice Address - Street 1:2425 HWY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5011
Practice Address - Country:US
Practice Address - Phone:817-540-4477
Practice Address - Fax:817-510-0188
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074241363A00000X
TXPA04954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J3334Medicare PIN