Provider Demographics
NPI:1598391393
Name:JORDAN, HEATHER LEE-ANNE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEE-ANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:480-418-3323
Practice Address - Street 1:6116 E ARBOR AVE STE 118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6104
Practice Address - Country:US
Practice Address - Phone:480-924-1552
Practice Address - Fax:480-830-8417
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240348363LF0000X
CA95030287163W00000X
AZRN181447163W00000X
WARN60691817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse