Provider Demographics
NPI:1538629993
Name:JORDAN, JOANNA L (DOULA, MSP, CBE)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DOULA, MSP, CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 LIME ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3089
Mailing Address - Country:US
Mailing Address - Phone:904-947-5057
Mailing Address - Fax:
Practice Address - Street 1:1655 LIME ST APT 5B
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3089
Practice Address - Country:US
Practice Address - Phone:904-947-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula