Provider Demographics
NPI:1093412827
Name:JORDAN, PATRINYA
Entity Type:Individual
Prefix:
First Name:PATRINYA
Middle Name:
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 1:2150 SOUTEL DR STE 7
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2281
Mailing Address - Country:US
Mailing Address - Phone:904-686-4939
Mailing Address - Fax:
Practice Address - Street 1:2150 SOUTEL DR STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2281
Practice Address - Country:US
Practice Address - Phone:904-437-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No172A00000XOther Service ProvidersDriver