Provider Demographics
NPI:1013559350
Name:GOLD, JORDAN (FNP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:BARDOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8305 CALEDONIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5431
Mailing Address - Country:US
Mailing Address - Phone:512-289-3339
Mailing Address - Fax:
Practice Address - Street 1:3918 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2901
Practice Address - Country:US
Practice Address - Phone:512-640-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily