Provider Demographics
NPI:1255703088
Name:JORDAN, TINA (FNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HIGHPOINT WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4699
Mailing Address - Country:US
Mailing Address - Phone:404-606-8430
Mailing Address - Fax:
Practice Address - Street 1:345 HUNTINGTON PLACE CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8651
Practice Address - Country:US
Practice Address - Phone:678-272-7280
Practice Address - Fax:678-610-6025
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 98431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily