Provider Demographics
NPI:1326626656
Name:DE LEON, JORGE LUIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:DE LEON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WOOTTON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1066
Mailing Address - Country:US
Mailing Address - Phone:240-453-6000
Mailing Address - Fax:
Practice Address - Street 1:1001 WELCH
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-4007
Practice Address - Country:US
Practice Address - Phone:512-218-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1028681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily