Provider Demographics
NPI:1457800161
Name:ROMERO, JORGE JR (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ROMERO
Suffix:JR
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 MDG
Mailing Address - Street 2:221 3RD ST WEST
Mailing Address - City:JBSA RANDOLPH AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:359 MDG
Practice Address - Street 2:221 3RD STREET WEST
Practice Address - City:JBSA RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-3765
Practice Address - Fax:210-652-7128
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201286163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse