Provider Demographics
NPI:1104336387
Name:AUGUSTIN, JORDAN J (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:J
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15385 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2844
Mailing Address - Country:US
Mailing Address - Phone:954-461-3172
Mailing Address - Fax:
Practice Address - Street 1:5100 N FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3842
Practice Address - Country:US
Practice Address - Phone:754-777-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01462500363LP0808X
FLAPRN9351187363LP0808X
FLARNP9351187363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care