MEDICARE: DARYL J GORDON CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP010668	PA
2	363LF0000X	Family Nurse Practitioner	SP010668	PA

General Provider Information

NPI Number	:	1275863839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL J GORDON CRNP

Provider Business Mailing Address
First Line	:	1122 NORTH ST
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1717
Country	:	US
Telephone Number	:	484-526-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 NORTH ST
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1717
Country	:	US
Telephone Number	:	484-526-6545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	09/29/2025

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