Provider Demographics
NPI:1700216983
Name:POPOVICH, JORDANA FAITH (CRNP)
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:FAITH
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2229
Mailing Address - Country:US
Mailing Address - Phone:610-649-2652
Mailing Address - Fax:
Practice Address - Street 1:701 MONTGOMERY AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-2036
Practice Address - Country:US
Practice Address - Phone:610-642-9200
Practice Address - Fax:610-649-4723
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024740363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics