Provider Demographics
NPI:1992099048
Name:JORDAN, NAN JEANNE (FNP)
Entity type:Individual
Prefix:MS
First Name:NAN
Middle Name:JEANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 3RD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5025
Mailing Address - Country:US
Mailing Address - Phone:970-247-2214
Mailing Address - Fax:
Practice Address - Street 1:1970 E 3RD AVE STE 102
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5025
Practice Address - Country:US
Practice Address - Phone:512-569-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610490363LF0000X
COC-APN.0002961-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily