Healthcare Provider Details

I. General information

NPI: 1063348340
Provider Name (Legal Business Name): JAIME LEIGH JORDAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10617 N 39TH WAY
PHOENIX AZ
85028-3420
US

IV. Provider business mailing address

10617 N 39TH WAY
PHOENIX AZ
85028-3420
US

V. Phone/Fax

Practice location:
  • Phone: 719-661-2127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number263793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: