Provider Demographics
NPI:1477769115
Name:JORDAN, MONICA F (CNM)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:F
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 NW 100TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1465
Mailing Address - Country:US
Mailing Address - Phone:954-431-1211
Mailing Address - Fax:954-431-9298
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:# 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-431-1211
Practice Address - Fax:954-431-1211
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203540367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY113POtherBCBS OF FL