Provider Demographics
NPI:1205827326
Name:REINKE, CAROLINE BOCK (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:BOCK
Last Name:REINKE
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:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-355-5100
Mailing Address - Fax:704-355-5180
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-355-5100
Practice Address - Fax:704-355-5180
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201679363LF0000X
NC181370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205827326Medicaid
NC7003874Medicaid
NC7003682Medicaid
NC7003682Medicaid
NC7003874Medicaid
NC2807089Medicare PIN
NCP73709Medicare UPIN