Provider Demographics
NPI:1265200760
Name:JORDAN, NATASHA NICOLE
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:NICOLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 GROUND DOVE CIR
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6931
Mailing Address - Country:US
Mailing Address - Phone:954-647-3153
Mailing Address - Fax:
Practice Address - Street 1:264 GROUND DOVE CIR
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6931
Practice Address - Country:US
Practice Address - Phone:954-647-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No174200000XOther Service ProvidersMeals
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No251E00000XAgenciesHome Health
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide