Provider Demographics
NPI:1659187375
Name:STARKE, JORDAN BLAKE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAKE
Last Name:STARKE
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 1:1284 SUNKEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:23881-8029
Mailing Address - Country:US
Mailing Address - Phone:804-892-1742
Mailing Address - Fax:
Practice Address - Street 1:15564 WESTCHESTER COMMONS WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7321
Practice Address - Country:US
Practice Address - Phone:804-440-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant