Provider Demographics
NPI:1992078158
Name:JORGENSON, JULIE ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:JORGENSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746654
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6654
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5469
Practice Address - Country:US
Practice Address - Phone:904-202-7300
Practice Address - Fax:904-202-2754
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022722363L00000X, 363LF0000X
KY300725363LF0000X
NC5010168363L00000X
KY3007250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50042294OtherPASSPORT- NORTON SURGICAL SPECIALISTS
IN201105490Medicaid
KY7100211110Medicaid
IN201105490Medicaid