Provider Demographics
NPI:1023459104
Name:RUFFIN, JENIFER ALISE (PA-C)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:ALISE
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:ALISE
Other - Last Name:ARNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4407 BEE CAVES ROAD BUILDING 1, SUITE 112
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-328-4999
Mailing Address - Fax:
Practice Address - Street 1:4407 BEE CAVES ROAD BUILDING 1, SUITE 112
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-328-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant