MEDICARE: JORGE L COYAGO 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	RN286887	GA

General Provider Information

NPI Number	:	1710791421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE L COYAGO FNP

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:	205-545-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6999 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5837
Country	:	US
Telephone Number	:	912-228-3523
Fax Number	:	912-304-4737

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	06/11/2025

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