Provider Demographics
NPI:1154361384
Name:JORDAN, ROBIN E (APRN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 W MCCOWN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6347
Mailing Address - Country:US
Mailing Address - Phone:843-662-2129
Mailing Address - Fax:
Practice Address - Street 1:3709 MAGNOLIA ST
Practice Address - Street 2:SC NEPHROLOGY AND HYPERTENSION
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1403
Practice Address - Country:US
Practice Address - Phone:803-531-2220
Practice Address - Fax:803-531-7975
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAP68363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0725Medicaid
SCNP0725Medicaid