Physician Compare National (NPI:1902437023)

HEALTHCARE PROVIDER: CRYSTAL NICHOLE JORDAN APRN, FNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902437023
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092131797
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200812001010
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JORDAN
	Individual professional last name
Provider First Name	CRYSTAL
	Individual professional first name
Provider Middle Name	NICHOLE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2019
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5662 TRANQUILITY OAKS DR
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 204
	Group Practice or individual's line 2 address
City	TAMPA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	336245846
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7276861402
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y