Healthcare Provider Details

I. General information

NPI: 1528831815
Provider Name (Legal Business Name): JORDAN LUEDY APRN-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 38TH AVE N
ST PETERSBURG FL
33710-1629
US

IV. Provider business mailing address

2004 TREADWAY AVE
CLEVELAND OH
44109-3657
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.452901
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: