Provider Demographics
NPI:1437135894
Name:JORGE, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:JORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUNDIAL PT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6622
Mailing Address - Country:US
Mailing Address - Phone:407-699-6009
Mailing Address - Fax:407-699-6008
Practice Address - Street 1:1301 SUNDIAL PT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6622
Practice Address - Country:US
Practice Address - Phone:407-699-6009
Practice Address - Fax:407-699-6008
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90543207R00000X
FLME 90543170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001751500Medicaid
FL50434TMedicare PIN
FLI25893Medicare UPIN