Basic Information
| Provider Information | |||||||||
| NPI: | 1396931200 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANA M. JORQUERA MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9765 SAN JOSE BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322575467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042681166 | ||||||||
| FaxNumber: | 9042681037 | ||||||||
| Practice Location | |||||||||
| Address1: | 9765 SAN JOSE BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322575467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042681166 | ||||||||
| FaxNumber: | 9042681037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | JORQUERA | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9042681166 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME47293 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 130017325 | 01 | FL | RAILROAD MEDICARE | OTHER | 056715900 | 05 | FL | MEDICAID |