Provider Demographics
NPI:1144636275
Name:ELLIS, JORDAN MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MARIE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 WESTGATE CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8195
Mailing Address - Country:US
Mailing Address - Phone:615-941-8550
Mailing Address - Fax:615-941-8507
Practice Address - Street 1:1642 WESTGATE CIR STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8195
Practice Address - Country:US
Practice Address - Phone:615-941-8550
Practice Address - Fax:615-941-8507
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily