Provider Demographics
NPI:1659897635
Name:GORAL, JEREMY MICHAEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:GORAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 SOUTH LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714
Mailing Address - Country:US
Mailing Address - Phone:520-294-1740
Mailing Address - Fax:
Practice Address - Street 1:2380 N FERGUSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2837
Practice Address - Country:US
Practice Address - Phone:520-324-1010
Practice Address - Fax:520-324-0029
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily