Healthcare Provider Details

I. General information

NPI: 1649344094
Provider Name (Legal Business Name): CAROLYN ANN JORDAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOSTON MEDICAL CENTER, 801 MASSACHUSETTS AVE CROSSTOWN BUILDING 6TH FLOOR
BOSTON MA
02118
US

IV. Provider business mailing address

BOSTON MEDICAL CENTER, 801 MASSACHUSETTS AVE CROSSTOWN BUILDING 6TH FLOOR
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5951
  • Fax: 617-414-9334
Mailing address:
  • Phone: 617-414-5951
  • Fax: 617-414-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN256168
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN256168
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: