Provider Demographics
NPI:1851529143
Name:JORDAN, MELISSA B (AP, DAHM, DIPL OM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:JORDAN
Suffix:
Gender:F
Credentials:AP, DAHM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4244
Mailing Address - Country:US
Mailing Address - Phone:904-260-2598
Mailing Address - Fax:904-260-2599
Practice Address - Street 1:8855 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4244
Practice Address - Country:US
Practice Address - Phone:904-260-2598
Practice Address - Fax:904-260-2599
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist