Provider Demographics
NPI:1356990576
Name:JORDAN, CHLOE CHERI
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:CHERI
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 1:2920 NW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1514
Mailing Address - Country:US
Mailing Address - Phone:919-561-0010
Mailing Address - Fax:
Practice Address - Street 1:2920 NW 122ND AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1514
Practice Address - Country:US
Practice Address - Phone:919-561-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty