Provider Demographics
NPI:1437639242
Name:JORDAN, PATIENCE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 BAYOULAND DR
Mailing Address - Street 2:
Mailing Address - City:PARKS
Mailing Address - State:LA
Mailing Address - Zip Code:70582-6266
Mailing Address - Country:US
Mailing Address - Phone:337-789-1444
Mailing Address - Fax:
Practice Address - Street 1:2390 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4205
Practice Address - Country:US
Practice Address - Phone:337-261-6100
Practice Address - Fax:337-261-6102
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily