Healthcare Provider Details

I. General information

NPI: 1730901828
Provider Name (Legal Business Name): JORDAN ASHLEIGH EAVES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 340
TAMPA FL
33613-4681
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 340
TAMPA FL
33613-4681
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4290
  • Fax:
Mailing address:
  • Phone: 813-467-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: