Provider Demographics
NPI:1073237020
Name:JGK, LLC
Entity Type:Organization
Organization Name:JGK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CLINICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LO MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:520-704-6787
Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:STE 260
Mailing Address - City:TUSCON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:STE 260
Practice Address - City:TUSCON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-704-6787
Practice Address - Fax:520-849-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty