Provider Demographics
NPI:1437322047
Name:JORDAN, GRACE A (PA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:850 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5946
Mailing Address - Fax:757-261-0071
Practice Address - Street 1:301 RIVERVIEW AVE STE 202A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9015
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2021-07-21
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110002802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant