Provider Demographics
NPI:1962227413
Name:JORDAN, ANDREA (PMHNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CLARKE-JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:15101 SW 23RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5891
Mailing Address - Country:US
Mailing Address - Phone:786-897-1674
Mailing Address - Fax:
Practice Address - Street 1:10080 N WOLFE RD STE SW3200
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2594
Practice Address - Country:US
Practice Address - Phone:786-809-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95030814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health