Healthcare Provider Details

I. General information

NPI: 1275012288
Provider Name (Legal Business Name): JORDAN RIMSA DNP FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N HIGHLAND AVE
MURFREESBORO TN
37130-2495
US

IV. Provider business mailing address

PO BOX 213
LASCASSAS TN
37085-0213
US

V. Phone/Fax

Practice location:
  • Phone: 615-904-8911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000229541
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000024399
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: