Provider Demographics
NPI:1588672331
Name:JORDAN, CARRIE R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:R
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:R
Other - Last Name:CZAPLICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5 ROSE LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471
Mailing Address - Country:US
Mailing Address - Phone:203-483-9124
Mailing Address - Fax:
Practice Address - Street 1:7365 MAIN ST STE 310
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1300
Practice Address - Country:US
Practice Address - Phone:203-384-3174
Practice Address - Fax:203-384-4619
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAPRN003213367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430001087Medicare ID - Type Unspecified