Healthcare Provider Details

I. General information

NPI: 1043277221
Provider Name (Legal Business Name): JANICE F RUBBELKE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SOUTHLAKE BLVD SUITE 200
SOUTHLAKE TX
76092-6251
US

IV. Provider business mailing address

1921 PRESTON RD SUITE 2008
PLANO TX
75093-5124
US

V. Phone/Fax

Practice location:
  • Phone: 817-488-1956
  • Fax: 817-488-8675
Mailing address:
  • Phone: 972-381-9300
  • Fax: 972-381-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number656557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: