Provider Demographics
NPI:1437281243
Name:GORDON, JANE LOUISE (NP-PP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LOUISE
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP-PP
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:LOUISE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 WALKER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-4743
Mailing Address - Country:US
Mailing Address - Phone:703-407-8276
Mailing Address - Fax:
Practice Address - Street 1:42 DALLAS HILL RD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-4032
Practice Address - Country:US
Practice Address - Phone:207-864-3303
Practice Address - Fax:207-864-2969
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608781NPPP363LF0000X
GA1053165363LF0000X
FLARNP9296651363LF0000X
MECNP191103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001328700Medicaid
FLCJ243ZOtherMEDICARE PTAN