Provider Demographics
NPI:1700070695
Name:JORDAN, TERRI POLITO (ARNP, BC-GNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:POLITO
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ARNP, BC-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 N COCOA BLVD
Mailing Address - Street 2:STE A TEHC HEALTH CARE
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7544
Mailing Address - Country:US
Mailing Address - Phone:321-453-5535
Mailing Address - Fax:321-456-5934
Practice Address - Street 1:846 N COCOA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7544
Practice Address - Country:US
Practice Address - Phone:321-453-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 1705612163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse