Provider Demographics
NPI:1346223757
Name:JORDAN, NAITTE P (FNP)
Entity Type:Individual
Prefix:
First Name:NAITTE
Middle Name:P
Last Name:JORDAN
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 1:400 W I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3459
Mailing Address - Country:US
Mailing Address - Phone:209-826-0195
Mailing Address - Fax:209-827-0554
Practice Address - Street 1:400 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3459
Practice Address - Country:US
Practice Address - Phone:209-826-0195
Practice Address - Fax:209-827-0554
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF4199363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMJ0993332OtherDEA CERT
CAMJ0993332OtherDEA CERT
CAPTAN,AQ184ZMedicare PIN
CAZZZ30840ZMedicare ID - Type Unspecified