Provider Demographics
NPI:1699899773
Name:JORDAN, TINA (BSN)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 AEGINA CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4825
Mailing Address - Country:US
Mailing Address - Phone:708-444-7179
Mailing Address - Fax:708-818-7880
Practice Address - Street 1:47 AEGINA CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4825
Practice Address - Country:US
Practice Address - Phone:708-444-7179
Practice Address - Fax:708-818-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse