Healthcare Provider Details

I. General information

NPI: 1184013948
Provider Name (Legal Business Name): GINA NICOLE RUBIDOUX FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 WYOMING BLVD NE STE D4
ALBUQUERQUE NM
87113-2013
US

IV. Provider business mailing address

413 VISTA ROJA PL NE
RIO RANCHO NM
87124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 505-844-8584
  • Fax:
Mailing address:
  • Phone: 505-681-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: