Provider Demographics
NPI:1295284172
Name:PLAXICO, JORDAN (RN, MSN, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:PLAXICO
Suffix:
Gender:F
Credentials:RN, MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 THOMPSON LN STE 30330
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 WESTWOOD PL STE 110
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7554
Practice Address - Country:US
Practice Address - Phone:615-206-2462
Practice Address - Fax:833-983-2043
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210223163W00000X
TN22109363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse