Healthcare Provider Details

I. General information

NPI: 1013892793
Provider Name (Legal Business Name): CHARISSA MARIE ELY JORDAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARISSA MARIE ELY

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRAMBLE BUSH DR
FALMOUTH MA
02540-2325
US

IV. Provider business mailing address

10 BRAMBLE BUSH DR
FALMOUTH MA
02540-2325
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-1801
  • Fax:
Mailing address:
  • Phone: 774-392-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2318744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: