MEDICARE: MR. JEFFREY PAUL JORDAN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA.11816-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770890055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY PAUL JORDAN NP-C

Provider Business Mailing Address
First Line	:	36060 EUCLID AVE
Second Line	:	STE 107
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-375-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	36060 EUCLID AVE
Second Line	:	STE 107
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-375-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	03/10/2022

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