Healthcare Provider Details

I. General information

NPI: 1336767185
Provider Name (Legal Business Name): TEENA RUBY GORE ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MACGREGOR PINES DR STE 310A
CARY NC
27511-6037
US

IV. Provider business mailing address

160 MACGREGOR PINES DR STE 310A
CARY NC
27511-6037
US

V. Phone/Fax

Practice location:
  • Phone: 919-390-2848
  • Fax: 984-246-1469
Mailing address:
  • Phone: 919-390-2848
  • Fax: 984-246-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5013295
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5013295
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5013295
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013295
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5013295
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number5013295
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5013295
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5013295
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number5013295
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: