Healthcare Provider Details

I. General information

NPI: 1164048088
Provider Name (Legal Business Name): ERICA JANE JORDAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12781 MAPLE GROVE LN
TRUMANN AR
72472-9742
US

IV. Provider business mailing address

12781 MAPLE GROVE LN
TRUMANN AR
72472-9742
US

V. Phone/Fax

Practice location:
  • Phone: 901-503-5758
  • Fax:
Mailing address:
  • Phone: 901-503-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125576
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125576
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: