Healthcare Provider Details

I. General information

NPI: 1740663798
Provider Name (Legal Business Name): JORDAN P HOBBS CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 GREENVIEW DR SW STE 160
ROCHESTER MN
55902-4326
US

IV. Provider business mailing address

1652 GREENVIEW DR SW STE 160
ROCHESTER MN
55902-4326
US

V. Phone/Fax

Practice location:
  • Phone: 507-328-0634
  • Fax: 612-567-4497
Mailing address:
  • Phone: 507-328-0634
  • Fax: 612-567-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3965
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberCNP3965
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: