Healthcare Provider Details

I. General information

NPI: 1861632176
Provider Name (Legal Business Name): JENNIFER LINDA JORDAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LINDA MACE PMHNP

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 PARK HUNT CT
SPRINGFIELD VA
22153-1364
US

IV. Provider business mailing address

9433 PARK HUNT CT
SPRINGFIELD VA
22153-1364
US

V. Phone/Fax

Practice location:
  • Phone: 301-642-5404
  • Fax:
Mailing address:
  • Phone: 301-642-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number184613
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024179751
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN727829
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1007817
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: