Provider Demographics
NPI:1396931200
Name:ANA M. JORQUERA MD PA
Entity type:Organization
Organization Name:ANA M. JORQUERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:JORQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-268-1166
Mailing Address - Street 1:9765 SAN JOSE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5467
Mailing Address - Country:US
Mailing Address - Phone:904-268-1166
Mailing Address - Fax:904-268-1037
Practice Address - Street 1:9765 SAN JOSE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5467
Practice Address - Country:US
Practice Address - Phone:904-268-1166
Practice Address - Fax:904-268-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL130017325OtherRAILROAD MEDICARE
FL056715900Medicaid
FL130017325OtherRAILROAD MEDICARE
FLD50559Medicare UPIN
FL056715900Medicaid