Provider Demographics
NPI:1700027307
Name:JORDAN, AMBROSHA NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:AMBROSHA
Middle Name:NICOLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBROSHA
Other - Middle Name:NICOLE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2266 N HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8254
Mailing Address - Country:US
Mailing Address - Phone:704-483-2200
Mailing Address - Fax:704-483-2214
Practice Address - Street 1:3626 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1388
Practice Address - Country:US
Practice Address - Phone:704-366-7182
Practice Address - Fax:704-366-7184
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
196518OtherNC LICENSE