Provider Demographics
NPI:1508649153
Name:JORDAN, BROOKE ALEXIS (APRN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXIS
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 11TH STREET A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6816
Mailing Address - Country:US
Mailing Address - Phone:309-428-3794
Mailing Address - Fax:
Practice Address - Street 1:4500 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1626
Practice Address - Country:US
Practice Address - Phone:563-742-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA175915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner