Healthcare Provider Details

I. General information

NPI: 1245162767
Provider Name (Legal Business Name): JORDAN P HAGANS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN PEEBLES APRN

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

V. Phone/Fax

Practice location:
  • Phone: 771-461-4000
  • Fax:
Mailing address:
  • Phone: 772-480-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: