Provider Demographics
NPI:1376966606
Name:GLOVER, JORDAN N (CRNA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:GLOVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 CORONA DR STE 232
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4323
Mailing Address - Country:US
Mailing Address - Phone:361-857-8525
Mailing Address - Fax:361-857-8809
Practice Address - Street 1:4444 CORONA DR STE 232
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4323
Practice Address - Country:US
Practice Address - Phone:361-857-8525
Practice Address - Fax:361-857-8809
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX772695367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered