Provider Demographics
NPI:1164172532
Name:PAOLUCCI, JORDAN JUDITH (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:JUDITH
Last Name:PAOLUCCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 EAGLET WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3860
Mailing Address - Country:US
Mailing Address - Phone:407-921-6750
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9907
Practice Address - Country:US
Practice Address - Phone:918-747-5322
Practice Address - Fax:918-746-7604
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program