Provider Demographics
NPI:1366844516
Name:COGGIN, JORDAN BLAIR HUFFMAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAIR HUFFMAN
Last Name:COGGIN
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 1:12621 MOORES MILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7895
Mailing Address - Country:US
Mailing Address - Phone:704-239-5982
Mailing Address - Fax:
Practice Address - Street 1:7920 SAM FURR RD
Practice Address - Street 2:MINUTECLINIC DIAGNOSTIC OF NORTH CAROLINA, P.C.
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8911
Practice Address - Country:US
Practice Address - Phone:704-896-3671
Practice Address - Fax:704-892-9324
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily