Provider Demographics
NPI:1730323981
Name:JORDAN, CECILIA LORRAINE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:LORRAINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 FENWOOD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2401
Mailing Address - Country:US
Mailing Address - Phone:516-285-7648
Mailing Address - Fax:
Practice Address - Street 1:6010 BAY PKWY
Practice Address - Street 2:GERIATRIC MEDICINE, P.C, D/B/A DOCTORS ON CALL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6079
Practice Address - Country:US
Practice Address - Phone:718-238-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340695-1363LG0600X
NYF304796-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology