Provider Demographics
NPI:1619583457
Name:KORENGE, JAMIE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:KORENGE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 NW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2920
Mailing Address - Country:US
Mailing Address - Phone:813-363-4336
Mailing Address - Fax:
Practice Address - Street 1:2801 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5727
Practice Address - Country:US
Practice Address - Phone:954-727-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner