Provider Demographics
NPI:1932205903
Name:JORDAN, PATRICIA W (APN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLIAM NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4754
Mailing Address - Country:US
Mailing Address - Phone:931-454-0489
Mailing Address - Fax:931-454-2348
Practice Address - Street 1:1615 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3179
Practice Address - Country:US
Practice Address - Phone:931-728-6205
Practice Address - Fax:931-728-9818
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4139434OtherBLUE CROSS
TN3347158Medicaid
TN3347158Medicaid
TN4139434OtherBLUE CROSS
S70117Medicare UPIN