Provider Demographics
NPI:1588636591
Name:JORDAN, MARIA VIRGINIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VIRGINIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:M
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:14499 COUNTY ROAD U
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-9594
Mailing Address - Country:US
Mailing Address - Phone:719-274-5300
Mailing Address - Fax:
Practice Address - Street 1:19021 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9427
Practice Address - Country:US
Practice Address - Phone:719-274-6000
Practice Address - Fax:719-274-6038
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07683394Medicaid
CO07683394Medicaid
804265Medicare PIN