Provider Demographics
NPI:1376847566
Name:RUKAVINA, GABRIELA DEVORA (NNP)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:DEVORA
Last Name:RUKAVINA
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18714 N THOMAS SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2392
Mailing Address - Country:US
Mailing Address - Phone:512-589-9917
Mailing Address - Fax:
Practice Address - Street 1:23900 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:512-589-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666864363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal