Healthcare Provider Details

I. General information

NPI: 1235936691
Provider Name (Legal Business Name): JORDAN ANDREW WININGS RN BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2224
  • Fax: 904-953-0272
Mailing address:
  • Phone: 904-953-2224
  • Fax: 904-953-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9469229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: