Provider Demographics
NPI:1629638879
Name:MILLIARD, JOURDAN DARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOURDAN
Middle Name:DARIA
Last Name:MILLIARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOURDAN
Other - Middle Name:DARIA
Other - Last Name:GRABOWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 W THOMAS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4407
Mailing Address - Country:US
Mailing Address - Phone:602-406-6262
Mailing Address - Fax:
Practice Address - Street 1:240 W THOMAS RD STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4407
Practice Address - Country:US
Practice Address - Phone:855-900-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily