MEDICARE: ALEXANDRA JORDAN NP

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	363L00000X	Nurse Practitioner	658804	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00149168	OTHER	TX	DPS#
2	658804	OTHER	TX	STATE LICENSE
3	06965	OTHER	TX	PRESCRIPTION ID#

General Provider Information

NPI Number	:	1962422097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA JORDAN NP

Provider Business Mailing Address
First Line	:	7336 SKYROCKET DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3117
Country	:	US
Telephone Number	:	915-526-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 TETONS DRIVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904
Country	:	US
Telephone Number	:	915-751-0908
Fax Number	:	915-757-3698

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/07/2023

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