Healthcare Provider Details

I. General information

NPI: 1013744820
Provider Name (Legal Business Name): JOSE D GIRON NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CALLE TAGORE APT 1712
SAN JUAN PR
00926-4765
US

IV. Provider business mailing address

18 CALLE TAGORE APT 1712
SAN JUAN PR
00926-4765
US

V. Phone/Fax

Practice location:
  • Phone: 470-529-7862
  • Fax: 470-529-7862
Mailing address:
  • Phone: 470-529-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042165
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2757
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number85590
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: