Healthcare Provider Details

I. General information

NPI: 1144064114
Provider Name (Legal Business Name): JORDAN DUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33214 KAYLEE WAY
LEESBURG FL
34788-3830
US

IV. Provider business mailing address

33214 KAYLEE WAY
LEESBURG FL
34788-3830
US

V. Phone/Fax

Practice location:
  • Phone: 717-542-6180
  • Fax:
Mailing address:
  • Phone: 717-542-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11048554
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9562977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: