Provider Demographics
NPI:1063884880
Name:WOOD, JORDAN PAUL (AGACNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAUL
Last Name:WOOD
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E BOYDSTUN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3958
Mailing Address - Country:US
Mailing Address - Phone:972-974-8139
Mailing Address - Fax:
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 408
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-361-9777
Practice Address - Fax:214-891-0084
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129292363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care