Provider Demographics
NPI:1811087109
Name:DORKIN, GEORGINA (FNP)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:DORKIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33077 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3109
Mailing Address - Country:US
Mailing Address - Phone:510-248-1500
Mailing Address - Fax:510-248-1500
Practice Address - Street 1:33077 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3109
Practice Address - Country:US
Practice Address - Phone:510-248-1500
Practice Address - Fax:510-248-1500
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7929DOOtherREGENCE BLUE SHIELD
WA7366432OtherAETNA QAFM
WA91-2145894OtherCOMMERCIAL QAFM
WA91-2145894OtherPREMERA BLUE CROSS QAFM
WA7929DOOtherREGENCE BLUE SHIELD
WA91-2145894OtherCOMMERCIAL QAFM