Provider Demographics
NPI:1043975105
Name:TASE, JORGE (APRN, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:TASE
Suffix:
Gender:M
Credentials:APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 FONTAINEBLEAU BLVD APT 401
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6820
Mailing Address - Country:US
Mailing Address - Phone:786-738-3682
Mailing Address - Fax:
Practice Address - Street 1:2215 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5357
Practice Address - Country:US
Practice Address - Phone:786-502-3857
Practice Address - Fax:786-391-3787
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025309363LF0000X, 363LP2300X
FLRN9544203163W00000X
FL2023208786363LP0808X
FLF03230441363L00000X
FL2340260062363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health