MEDICARE: JENNIFER RUBIO GREDICEK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SF0001X	Family Health Clinical Nurse Specialist	642100	TX
2	364SF0001X	Family Health Clinical Nurse Specialist	AP124084	TX
3	363L00000X	Nurse Practitioner	AP124084	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073946984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RUBIO GREDICEK NP

Provider Business Mailing Address
First Line	:	209 S CHURCH ST
Second Line	:	SUITE B
City	:	LOCKHART
State	:	TX
Zip	:	78644-2713
Country	:	US
Telephone Number	:	512-376-2999
Fax Number	:	512-376-5562

Provider Business Practice Location Address
First Line	:	500 N CAPITAL OF TEXAS HWY # 6
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-3302
Country	:	US
Telephone Number	:	855-481-8375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	09/18/2023

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