Provider Demographics
NPI:1396598579
Name:CHAVEZ, JORGE A (FNP)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 OLD STEESE HWY # B166
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3163
Mailing Address - Country:US
Mailing Address - Phone:720-202-3451
Mailing Address - Fax:
Practice Address - Street 1:751 OLD RICHARDSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7802
Practice Address - Country:US
Practice Address - Phone:907-328-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK219967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily