Provider Demographics
NPI:1033983309
Name:JORDAN, ARNETIA MITCHELL
Entity Type:Individual
Prefix:
First Name:ARNETIA
Middle Name:MITCHELL
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 BURGOYNE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3048
Mailing Address - Country:US
Mailing Address - Phone:904-414-9140
Mailing Address - Fax:
Practice Address - Street 1:2428 BURGOYNE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3048
Practice Address - Country:US
Practice Address - Phone:904-414-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health