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General NPI Number Information
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NPI Number | 1609206853
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Entity Type | Individual
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Provider Name | KERI NICOLE JORDAN R.N., N.N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/24/2013
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 1300 SAWGRASS CORPORATE PKWY
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City | SUNRISE
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State | FL
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Zip | 33323-2826
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Country | US
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Telephone | 800-243-3839
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 RIVERBROOK DR
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City | HERMITAGE
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State | TN
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Zip | 37076-3570
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Country | US
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Telephone | 615-342-4660
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Fax | 615-342-4662
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 18660
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 183833
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License Number State | TN
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