Healthcare Provider Details

I. General information

NPI: 1730558834
Provider Name (Legal Business Name): JACQUITA JORDAN FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 FONTAINE BLVD
FOUNTAIN CO
80817-1061
US

IV. Provider business mailing address

10265 ROLLING RIDGE RD
COLORADO SPRINGS CO
80925-9509
US

V. Phone/Fax

Practice location:
  • Phone: 719-653-7776
  • Fax: 719-207-7783
Mailing address:
  • Phone: 719-653-7776
  • Fax: 719-726-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0991885-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991885
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberAPN.0991885-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0991885
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0991885-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: