Provider Demographics
NPI:1356649503
Name:GERONIMO, RUBY APOLINARIO (NP-C)
Entity Type:Individual
Prefix:MS
First Name:RUBY
Middle Name:APOLINARIO
Last Name:GERONIMO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602458
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2458
Mailing Address - Country:US
Mailing Address - Phone:910-277-9164
Mailing Address - Fax:910-277-9189
Practice Address - Street 1:1600 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5524
Practice Address - Country:US
Practice Address - Phone:910-277-9164
Practice Address - Fax:910-277-9189
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268333363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3382Medicaid
NC1356649503Medicaid
SCNP3382Medicaid
NC1356649503Medicaid