Provider Demographics
NPI:1902180227
Name:NICQUETTE, JORDAN SWINDLE (PA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SWINDLE
Last Name:NICQUETTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SWINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2901 MONTOPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6411
Mailing Address - Country:US
Mailing Address - Phone:512-978-9901
Mailing Address - Fax:512-901-9782
Practice Address - Street 1:2901 MONTOPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6411
Practice Address - Country:US
Practice Address - Phone:512-978-9901
Practice Address - Fax:512-901-8742
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07488363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2046658-01Medicaid