Provider Demographics
NPI:1710791421
Name:COYAGO, JORGE L (FNP)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:COYAGO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WHITE BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3153
Mailing Address - Country:US
Mailing Address - Phone:912-604-8241
Mailing Address - Fax:
Practice Address - Street 1:2321 POOLER PKWY STE 107
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4423
Practice Address - Country:US
Practice Address - Phone:912-604-8241
Practice Address - Fax:912-328-1121
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily