Healthcare Provider Details

I. General information

NPI: 1164167680
Provider Name (Legal Business Name): JORDAN NICHOLE REPPOND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE
TULSA OK
74136-1907
US

IV. Provider business mailing address

1325 SAN MARCO BLVD STE 300
JACKSONVILLE FL
32207-8567
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-8500
  • Fax: 918-307-5578
Mailing address:
  • Phone: 904-253-6910
  • Fax: 904-253-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11010199530
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number222458
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: