Healthcare Provider Details

I. General information

NPI: 1962227413
Provider Name (Legal Business Name): ANDREA JORDAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA CLARKE-JORDAN PMHNP

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 N 1ST ST FL 2
SAN JOSE CA
95131-1035
US

IV. Provider business mailing address

2570 N 1ST ST FL 2
SAN JOSE CA
95131-1035
US

V. Phone/Fax

Practice location:
  • Phone: 786-809-1112
  • Fax:
Mailing address:
  • Phone: 786-897-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11038402
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95030814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: