Healthcare Provider Details

I. General information

NPI: 1437023819
Provider Name (Legal Business Name): MRS. JORDAN BROOKS CUBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 ELM ST
AYNOR SC
29511-3320
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-358-5806
  • Fax:
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31340
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: