Provider Demographics
NPI:1568033892
Name:CARVAJAL ORTIZ, JORGE ALEXIS (APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALEXIS
Last Name:CARVAJAL ORTIZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2133
Mailing Address - Country:US
Mailing Address - Phone:305-423-4044
Mailing Address - Fax:
Practice Address - Street 1:1479 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2133
Practice Address - Country:US
Practice Address - Phone:305-423-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily