Healthcare Provider Details

I. General information

NPI: 1437135894
Provider Name (Legal Business Name): VANESSA JORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SUNDIAL PT
WINTER SPRINGS FL
32708-6622
US

IV. Provider business mailing address

1301 SUNDIAL PT
WINTER SPRINGS FL
32708-6622
US

V. Phone/Fax

Practice location:
  • Phone: 407-699-6009
  • Fax: 407-699-6008
Mailing address:
  • Phone: 407-699-6009
  • Fax: 407-699-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME90543
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberME 90543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: