Provider Demographics
NPI:1205338910
Name:SILVA, JORGE LUIS SR (RN)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:SILVA
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30700 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3834
Mailing Address - Country:US
Mailing Address - Phone:305-299-9742
Mailing Address - Fax:786-610-0686
Practice Address - Street 1:30700 SW 188TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3834
Practice Address - Country:US
Practice Address - Phone:305-299-9742
Practice Address - Fax:786-610-0686
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9460941163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty