Provider Demographics
NPI:1790569598
Name:SURFUS, JORDAN SIERRA (NP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SIERRA
Last Name:SURFUS
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 1:3733 S OAKHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8070
Mailing Address - Country:US
Mailing Address - Phone:559-805-6198
Mailing Address - Fax:
Practice Address - Street 1:1110 S BEN MADDOX WAY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3643
Practice Address - Country:US
Practice Address - Phone:559-624-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026740363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner