MEDICARE: MRS. JULIE ANN JORGENSON APRN

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	363L00000X	Nurse Practitioner	APRN11022722	FL
2	363LF0000X	Family Nurse Practitioner	300725	KY
3	363L00000X	Nurse Practitioner	5010168	NC
4	363LF0000X	Family Nurse Practitioner	APRN11022722	FL
5	363LF0000X	Family Nurse Practitioner	3007250	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50042294	OTHER	KY	PASSPORT- NORTON SURGICAL SPECIALISTS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992078158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN JORGENSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 746654
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6654
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	14546 OLD SAINT AUGUSTINE RD STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5469
Country	:	US
Telephone Number	:	904-202-7300
Fax Number	:	904-202-2754

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

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	04/30/2025

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