Provider Demographics
NPI:1770111973
Name:DAMIANO, JORDAN NIKOLE (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NIKOLE
Last Name:DAMIANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 KEMPSVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3931
Mailing Address - Country:US
Mailing Address - Phone:757-455-6479
Mailing Address - Fax:757-466-9262
Practice Address - Street 1:880 KEMPSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3931
Practice Address - Country:US
Practice Address - Phone:757-455-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208535207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology