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1336767185

NPI Code Detail

MEDICARE: TEENA RUBY GORE ACNPC-AG

MEDICARE: TEENA RUBY GORE ACNPC-AG

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	363LG0600X	Gerontology Nurse Practitioner	5013295	NC
2	174400000X	Specialist	5013295	NC
3	363L00000X	Nurse Practitioner	5013295	NC
4	363LA2200X	Adult Health Nurse Practitioner	5013295	NC
5	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	5013295	NC
6	363LA2100X	Acute Care Nurse Practitioner	5013295	NC
7	2086S0129X	Vascular Surgery Physician	5013295	NC
8	363LC0200X	Critical Care Medicine Nurse Practitioner	5013295	NC

General Provider Information

NPI Number	:	1336767185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEENA RUBY GORE ACNPC-AG

Provider Business Mailing Address
First Line	:	3000 NEW BERN AVE STE 1100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1231
Country	:	US
Telephone Number	:	919-233-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NEW BERN AVE STE 1100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1231
Country	:	US
Telephone Number	:	919-233-6333
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	04/06/2026

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Directions to “ TEENA RUBY GORE ACNPC-AG” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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