Provider Demographics
NPI:1669026126
Name:GORDON HOPWOOD, JACQUELINE ANDREA (DNP)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANDREA
Last Name:GORDON HOPWOOD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:ANDREA
Other - Last Name:GORDON-HOPWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:1700 RIDGEWOOD AVE STE I
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1782
Mailing Address - Country:US
Mailing Address - Phone:585-233-0105
Mailing Address - Fax:
Practice Address - Street 1:5000 W COLONIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7602
Practice Address - Country:US
Practice Address - Phone:407-930-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner