Provider Demographics
NPI:1477646339
Name:JORDAN, CORINNE SANDRA
Entity Type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:SANDRA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 EDGEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8347
Mailing Address - Country:US
Mailing Address - Phone:321-452-2401
Mailing Address - Fax:
Practice Address - Street 1:141 EDGEWATER WAY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8347
Practice Address - Country:US
Practice Address - Phone:321-452-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18539251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health