Healthcare Provider Details

I. General information

NPI: 1316242597
Provider Name (Legal Business Name): VALERIE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4257 FRANCIS RD
JACKSONVILLE FL
32209-1905
US

IV. Provider business mailing address

4257 FRANCIS RD
JACKSONVILLE FL
32209-1905
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-6822
  • Fax:
Mailing address:
  • Phone: 904-383-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: