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General NPI Number Information
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NPI Number | 1992421325
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Entity Type | Individual
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Provider Name | JORGE FERNANDEZ NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 3809 COMPUTER DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27609-6518
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Country | US
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Telephone | 919-782-3782
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Fax | 919-782-3788
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Provider Business Mailing Address
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Address Line | 104 DARTMOUTH RD APT 512
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City | RALEIGH
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State | NC
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Zip | 27609-8416
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Country | US
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Telephone | 956-740-3787
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5020301
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License Number State | NC
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