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General NPI Number Information
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NPI Number | 1407563844
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Entity Type | Individual
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Provider Name | JORGE PENA FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 4055 VALLEY VIEW LN
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City | DALLAS
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State | TX
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Zip | 75244-5074
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Country | US
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Telephone | 214-238-5036
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Fax |
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Provider Business Mailing Address
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Address Line | 5646 MYSTIC BND
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City | BROWNSVILLE
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State | TX
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Zip | 78526-3835
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Country | US
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Telephone | 956-592-1160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1098283
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License Number State | TX
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