Healthcare Provider Details

I. General information

NPI: 1386293710
Provider Name (Legal Business Name): JORDAN FISHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN JEAN FISHER FNP

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2896
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2232
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178130
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: