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General NPI Number Information
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NPI Number | 1568290849
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Entity Type | Individual
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Provider Name | JESSICA GORDON APRN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 5130 LINTON BLVD STE G6
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6597
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Country | US
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Telephone | 561-501-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 3133 CLINT MOORE RD APT 106
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City | BOCA RATON
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State | FL
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Zip | 33496-3915
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Country | US
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Telephone | 713-907-6163
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11034308
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License Number State | FL
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