Healthcare Provider Details

I. General information

NPI: 1063929123
Provider Name (Legal Business Name): JORGE ALBERTO NAVARRO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY
FORT MYERS FL
33912-4336
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1612
  • Fax: 239-343-4229
Mailing address:
  • Phone: 239-343-1612
  • Fax: 239-343-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: