Healthcare Provider Details

I. General information

NPI: 1487467817
Provider Name (Legal Business Name): JORDAN MACH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E SHEA BLVD STE 100
PHOENIX AZ
85028-6031
US

IV. Provider business mailing address

4600 E SHEA BLVD STE 100
PHOENIX AZ
85028-6031
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-8700
  • Fax: 602-553-8142
Mailing address:
  • Phone: 602-955-8700
  • Fax: 602-553-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115830
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: