Provider Demographics
NPI:1336428176
Name:JORDAN, ELIZABETH A (LPC, RN, CRNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, RN, CRNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8001 STATE ROAD
Mailing Address - Street 2:MOD II, SUITE 107
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136
Mailing Address - Country:US
Mailing Address - Phone:215-624-0790
Mailing Address - Fax:215-524-2998
Practice Address - Street 1:8001 STATE ROAD
Practice Address - Street 2:MOD II, SUITE 107
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136
Practice Address - Country:US
Practice Address - Phone:215-624-0790
Practice Address - Fax:215-524-2998
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN662315163W00000X
PASP019102363LP0808X
PAPC005713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health