Provider Demographics
NPI:1861632176
Name:JORDAN, JENNIFER LINDA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LINDA
Other - Last Name:MACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:9151 BLARNEY STONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2146
Mailing Address - Country:US
Mailing Address - Phone:301-642-5404
Mailing Address - Fax:703-707-8657
Practice Address - Street 1:9151 BLARNEY STONE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2146
Practice Address - Country:US
Practice Address - Phone:301-642-5404
Practice Address - Fax:703-707-8657
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179751363LP0808X
CO184613163W00000X
CARN727829163W00000X
DCRN1007817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse