Provider Demographics
NPI:1477025260
Name:JORDAN, JASMINE A (NP)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:ANISSA KIAMA
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11803 JEFFERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4390
Mailing Address - Country:US
Mailing Address - Phone:757-594-1850
Mailing Address - Fax:
Practice Address - Street 1:11803 JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4390
Practice Address - Country:US
Practice Address - Phone:757-594-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily