Provider Demographics
NPI:1184609620
Name:JORQUERA, ANA MARIA (MD)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:JORQUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANA
Other - Middle Name:MARIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7855 ARGYLE FOREST BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5597
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:421 KINGSLEY AVE STE 400
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4898
Practice Address - Country:US
Practice Address - Phone:904-268-1166
Practice Address - Fax:904-268-1037
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME472932084N0400X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02560OtherBCBS
FL016588100Medicaid
FL02560OtherBCBS
593492206OtherHUMANA
FL056715900Medicaid
FLD50559Medicare UPIN