Provider Demographics
NPI:1598424632
Name:MANUEL, JORDYN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JORDYN
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46050 GOLD PLACE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AMANT
Mailing Address - State:LA
Mailing Address - Zip Code:70774-3708
Mailing Address - Country:US
Mailing Address - Phone:225-247-8542
Mailing Address - Fax:
Practice Address - Street 1:1 GALLERIA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-8501
Practice Address - Country:US
Practice Address - Phone:504-708-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily