MEDICARE: PATRICIA JORGENSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95001458	CA

General Provider Information

NPI Number	:	1235535162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA JORGENSON FNP

Provider Business Mailing Address
First Line	:	3010 BEARD RD
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-3442
Country	:	US
Telephone Number	:	707-255-8825
Fax Number	:	707-252-9325

Provider Business Practice Location Address
First Line	:	2351 W MARCH LN
Second Line	:	SUITE A
City	:	STOCKTON
State	:	CA
Zip	:	95207-5292
Country	:	US
Telephone Number	:	855-944-7246
Fax Number	:	888-991-8346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	03/29/2016

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