MEDICARE: GEORGINA VARGAS APRN

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	363LF0000X	Family Nurse Practitioner	APRN11009998	FL
2	363L00000X	Nurse Practitioner	APRN11009998	FL

General Provider Information

NPI Number	:	1740068659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGINA VARGAS APRN

Provider Business Mailing Address
First Line	:	3345 BURNS RD STE 105
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 S CONGRESS AVE STE B&C
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4734
Country	:	US
Telephone Number	:	561-967-1046
Fax Number	:	561-967-0167

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	03/26/2024

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