Healthcare Provider Details

I. General information

NPI: 1447834270
Provider Name (Legal Business Name): JORDAN MICHELLE HANDIN DNP, APRN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE STE 200
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-763-2702
  • Fax: 954-888-3961
Mailing address:
  • Phone: 954-763-2702
  • Fax: 954-888-3961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number11012897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: