Provider Demographics
NPI:1396384517
Name:STURGILL, JORDAN GRIFFIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:GRIFFIN
Last Name:STURGILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RAYE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3789
Mailing Address - Country:US
Mailing Address - Phone:252-551-3000
Mailing Address - Fax:252-551-3100
Practice Address - Street 1:2210 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3789
Practice Address - Country:US
Practice Address - Phone:252-551-3000
Practice Address - Fax:252-551-3100
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant