Provider Demographics
NPI:1619953163
Name:JORDAN, ESTHER K (ARNP)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:K
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:K
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 W MORENO ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-2316
Mailing Address - Country:US
Mailing Address - Phone:850-469-7406
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-469-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3075162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL591-83824OtherBLUE CROSS BLUE SHIELD
AL891010910Medicaid
FL303157800Medicaid
FLY9888OtherBLUE CROSS BLUE SHIELD
AL051532138Medicare ID - Type Unspecified
FL303157800Medicaid
AL591-83824OtherBLUE CROSS BLUE SHIELD