Provider Demographics
NPI:1679326599
Name:ECHEVERRY, JORGE ANDRES (PA-C)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ANDRES
Last Name:ECHEVERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8701 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-7524
Mailing Address - Country:US
Mailing Address - Phone:772-228-8480
Mailing Address - Fax:772-228-8481
Practice Address - Street 1:8701 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-7524
Practice Address - Country:US
Practice Address - Phone:772-228-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant