Provider Demographics
NPI:1770173940
Name:JORDAN, TRAYPANIEL THEODORE (MBA, BSN, RN)
Entity type:Individual
Prefix:MR
First Name:TRAYPANIEL
Middle Name:THEODORE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MBA, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 CEDAR BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5900
Mailing Address - Country:US
Mailing Address - Phone:813-846-8251
Mailing Address - Fax:
Practice Address - Street 1:3895 CEDAR BLUFF LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-5900
Practice Address - Country:US
Practice Address - Phone:813-846-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9494078163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency