Provider Demographics
NPI:1760014443
Name:JORDAN, NANCY ALICE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ALICE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E RIVER PARK PL W STE 440
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1547
Mailing Address - Country:US
Mailing Address - Phone:559-256-5500
Mailing Address - Fax:559-256-0029
Practice Address - Street 1:30 E RIVER PARK PL W STE 440
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1547
Practice Address - Country:US
Practice Address - Phone:559-256-5500
Practice Address - Fax:559-256-0029
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily