Provider Demographics
NPI:1245067222
Name:JORDAN, EMILY ISABEL (FNP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ISABEL
Last Name:JORDAN
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 1:19816 W MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6714
Mailing Address - Country:US
Mailing Address - Phone:518-894-3585
Mailing Address - Fax:
Practice Address - Street 1:13014 W CAMELBACK RD STE 102
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3079
Practice Address - Country:US
Practice Address - Phone:518-894-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ313638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily