Provider Demographics
NPI:1477896405
Name:BRAVO, JORGE LUIS (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:BRAVO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S CAGE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5458
Mailing Address - Country:US
Mailing Address - Phone:956-475-3031
Mailing Address - Fax:956-475-3680
Practice Address - Street 1:524 S CAGE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5458
Practice Address - Country:US
Practice Address - Phone:956-475-3031
Practice Address - Fax:956-475-3680
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily