Provider Demographics
NPI:1336521012
Name:JORDAN, ASHLEY (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 NW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1235
Mailing Address - Country:US
Mailing Address - Phone:781-710-5965
Mailing Address - Fax:
Practice Address - Street 1:1010 S FEDERAL HWY STE 1010
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5132
Practice Address - Country:US
Practice Address - Phone:561-331-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209249208600000X
FLME169377208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery