Healthcare Provider Details

I. General information

NPI: 1841940947
Provider Name (Legal Business Name): JOURDAN ALEXANDRA MCKINNIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

1700 SW 16TH CT APT B26
GAINESVILLE FL
32608-1579
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5159
  • Fax:
Mailing address:
  • Phone: 941-932-6379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: