Provider Demographics
NPI:1427047331
Name:JORDAN, SUSAN STARBUCK (RNC, FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:STARBUCK
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1207
Mailing Address - Country:US
Mailing Address - Phone:423-316-3085
Mailing Address - Fax:
Practice Address - Street 1:1039 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7900
Practice Address - Country:US
Practice Address - Phone:423-874-0125
Practice Address - Fax:423-874-0154
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006289363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103I501689Medicaid
TNQ008621Medicaid
TNQ008621Medicaid