MEDICARE: MS. NANETTE A JORGE

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	1041C0700X	Clinical Social Worker	SW-6879	FL

General Provider Information

NPI Number	:	1487977674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANETTE A JORGE

Provider Business Mailing Address
First Line	:	5535 45TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-2464
Country	:	US
Telephone Number	:	772-633-7933
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 45TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-2464
Country	:	US
Telephone Number	:	772-633-7933
Fax Number	:

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

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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