Provider Demographics
NPI:1851758627
Name:TAMANO, JORGE MA (MSN, APRN, A GNP C)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:MA
Last Name:TAMANO
Suffix:
Gender:M
Credentials:MSN, APRN, A GNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 RAGUSA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8045
Mailing Address - Country:US
Mailing Address - Phone:410-814-9302
Mailing Address - Fax:
Practice Address - Street 1:716 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8108
Practice Address - Country:US
Practice Address - Phone:415-934-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX864562163W00000X
FLAPRN11027934363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology