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General NPI Number Information
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NPI Number | 1679071617
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Entity Type | Individual
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Provider Name | JESSICA GORGOGLIONE APN-BC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 1380 E MEDICAL CENTER DR STE N1800
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City | ST GEORGE
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State | UT
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Zip | 84790-2123
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Country | US
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Telephone | 435-251-4100
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Fax | 435-251-1401
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone |
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Fax | 702-345-3063
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209.017090
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 819263
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11540806-4405
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License Number State | UT
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