Healthcare Provider Details

I. General information

NPI: 1053794396
Provider Name (Legal Business Name): JORDAN BOWLING R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CHARLOTTE AVE
NASHVILLE TN
37209-4129
US

IV. Provider business mailing address

2500 CHARLOTTE AVE
NASHVILLE TN
37209-4129
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-0388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200137
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: