Provider Demographics
NPI:1619771011
Name:JORDAN, JAZMINE INDIA (NP)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:INDIA
Last Name:JORDAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOMERSET HLS
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5203
Mailing Address - Country:US
Mailing Address - Phone:443-315-6582
Mailing Address - Fax:
Practice Address - Street 1:5 CONCOURSE PKWY STE 3100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-7117
Practice Address - Country:US
Practice Address - Phone:855-492-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily