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General NPI Number Information
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NPI Number | 1730558834
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Entity Type | Individual
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Provider Name | JACQUITA JORDAN FNP-BC, AGACNP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 1259 LAKE PLAZA DR STE 270
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3560
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Country | US
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Telephone | 719-653-7776
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Fax | 719-207-7783
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Provider Business Mailing Address
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Address Line | 10265 ROLLING RIDGE RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80925-9509
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Country | US
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Telephone | 719-653-7776
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Fax | 719-726-0002
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | APN.0991885-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APN.0991885-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0991885
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0991885-NP
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0991885
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License Number State | CO
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