Healthcare Provider Details

I. General information

NPI: 1235535162
Provider Name (Legal Business Name): PATRICIA JORGENSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 W MARCH LN SUITE A
STOCKTON CA
95207-5292
US

IV. Provider business mailing address

3010 BEARD RD
NAPA CA
94558-3442
US

V. Phone/Fax

Practice location:
  • Phone: 855-944-7246
  • Fax: 888-991-8346
Mailing address:
  • Phone: 707-255-8825
  • Fax: 707-252-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: