Provider Demographics
NPI:1912761792
Name:ADAMS, JORDANN ALEXANDRA (APRN)
Entity type:Individual
Prefix:
First Name:JORDANN
Middle Name:ALEXANDRA
Last Name:ADAMS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 11TH CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4838
Mailing Address - Country:US
Mailing Address - Phone:772-589-0580
Mailing Address - Fax:772-589-0760
Practice Address - Street 1:3745 11TH CIR STE 101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4838
Practice Address - Country:US
Practice Address - Phone:772-589-0580
Practice Address - Fax:772-589-0760
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030245207RG0100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122336100Medicaid