Healthcare Provider Details

I. General information

NPI: 1952281271
Provider Name (Legal Business Name): JORDAN PARKIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 ENTERPRISE RD
DEBARY FL
32713-5210
US

IV. Provider business mailing address

5929 BOGGS FORD RD
PORT ORANGE FL
32127-5881
US

V. Phone/Fax

Practice location:
  • Phone: 386-951-4538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11042085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: