Provider Demographics
NPI:1487264040
Name:REMON, JORGE ROLANDO (APRN)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ROLANDO
Last Name:REMON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5943
Mailing Address - Country:US
Mailing Address - Phone:305-336-6167
Mailing Address - Fax:
Practice Address - Street 1:6230 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5943
Practice Address - Country:US
Practice Address - Phone:305-336-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06201361OtherN/A