Provider Demographics
NPI:1154911824
Name:JORDAN, NAQUITA K (CNA CARE GIVER)
Entity type:Individual
Prefix:MRS
First Name:NAQUITA
Middle Name:K
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CNA CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 DIANNE DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5304
Mailing Address - Country:US
Mailing Address - Phone:321-305-7517
Mailing Address - Fax:
Practice Address - Street 1:2446 DIANNE DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5304
Practice Address - Country:US
Practice Address - Phone:321-305-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide