Provider Demographics
NPI:1366842809
Name:JURGENSEN, KATHARINE LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:LEIGH
Last Name:JURGENSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE STE 240
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3883
Mailing Address - Country:US
Mailing Address - Phone:678-961-0733
Mailing Address - Fax:
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE STE 240
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3883
Practice Address - Country:US
Practice Address - Phone:678-961-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily