Provider Demographics
NPI:1225706492
Name:EARLE, JORDAN ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELAINE
Last Name:EARLE
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:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-1117
Mailing Address - Country:US
Mailing Address - Phone:940-864-2621
Mailing Address - Fax:940-864-3739
Practice Address - Street 1:1400 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5426
Practice Address - Country:US
Practice Address - Phone:940-864-8513
Practice Address - Fax:940-864-2779
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily