Provider Demographics
NPI:1821595265
Name:GOMEZ, RUBY ANNETTE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RUBY
Middle Name:ANNETTE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-3989
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:6204 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4214
Practice Address - Country:US
Practice Address - Phone:512-427-9400
Practice Address - Fax:512-342-2723
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403746701Medicaid
TXH08LW21701OtherBCBS