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General NPI Number Information
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NPI Number | 1427338748
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Entity Type | Individual
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Provider Name | MICHELLE V JORDAN CPNP-AC/PC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 927 45TH ST STE 301
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City | WEST PALM BEACH
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State | FL
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Zip | 33407
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Country | US
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Telephone | 561-227-9240
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Fax | 561-842-9570
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Provider Business Mailing Address
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Address Line | P O BOX 601888
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City | CHARLOTTE
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State | NC
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Zip | 28260-1888
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Country | US
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Telephone | 704-403-2662
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Fax | 704-403-2670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP9490043
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5005260
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 221553
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5005260
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License Number State | NC
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