Provider Demographics
NPI:1184013948
Name:RUBIDOUX, GINA NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NICOLE
Last Name:RUBIDOUX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 VISTA ROJA PL NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1876
Mailing Address - Country:US
Mailing Address - Phone:505-681-8468
Mailing Address - Fax:
Practice Address - Street 1:8001 WYOMING BLVD NE STE D4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2013
Practice Address - Country:US
Practice Address - Phone:505-844-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily