Provider Demographics
NPI:1689095044
Name:JORDAN, LADWYANA
Entity Type:Individual
Prefix:
First Name:LADWYANA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LAKE AVE APT 206A
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6391
Mailing Address - Country:US
Mailing Address - Phone:407-782-4506
Mailing Address - Fax:
Practice Address - Street 1:330 LAKE AVE APT 206A
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6391
Practice Address - Country:US
Practice Address - Phone:407-782-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist