Provider Demographics
NPI:1225131576
Name:RINER, JACQUELINE MICHELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:RINER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MICHELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:3 RAVDIN BUILDING, SUITE F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3202
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:3 RAVDIN BUILDING, SUITE F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075335Medicare PIN
Q02975Medicare UPIN