Provider Demographics
NPI:1376049965
Name:JORDON, STEPHANIE LYNNE (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:JORDON
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNNE
Other - Last Name:PILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9765 SAN JOSE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5467
Mailing Address - Country:US
Mailing Address - Phone:904-260-5757
Mailing Address - Fax:904-268-0733
Practice Address - Street 1:9765 SAN JOSE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-260-5757
Practice Address - Fax:904-268-0733
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily