Healthcare Provider Details

I. General information

NPI: 1609337575
Provider Name (Legal Business Name): CHRISTINA JORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA NORTON

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1624
US

IV. Provider business mailing address

PO BOX 1328
UNION CITY TN
38281-1328
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-0810
  • Fax:
Mailing address:
  • Phone: 731-514-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: