Healthcare Provider Details

I. General information

NPI: 1811477078
Provider Name (Legal Business Name): JORDAN BUDWICK APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4703
US

IV. Provider business mailing address

PO BOX 100236
GAINESVILLE FL
32610-0236
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5550
  • Fax: 352-273-5575
Mailing address:
  • Phone: 352-273-5550
  • Fax: 352-273-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9416676
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9416676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: