Provider Demographics
NPI:1992421325
Name:FERNANDEZ, JORGE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DARTMOUTH RD APT 512
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8416
Mailing Address - Country:US
Mailing Address - Phone:956-740-3787
Mailing Address - Fax:
Practice Address - Street 1:3809 COMPUTER DR STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6518
Practice Address - Country:US
Practice Address - Phone:919-782-3782
Practice Address - Fax:919-782-3788
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner