Provider Demographics
NPI:1932729241
Name:JORDAN, CHEVELLE R (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CHEVELLE
Middle Name:R
Last Name:JORDAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 APOLLO BEACH BLVD # 182
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2251
Mailing Address - Country:US
Mailing Address - Phone:866-757-5858
Mailing Address - Fax:866-757-5858
Practice Address - Street 1:239 CASCADE BEND DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6396
Practice Address - Country:US
Practice Address - Phone:866-757-5858
Practice Address - Fax:866-757-5858
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9402527163WH1000X, 163W00000X, 163WC0400X, 163WC2100X, 163WH0200X, 163WU0100X, 163WW0000X, 163WX1500X, 163WG0000X
171M00000X, 251B00000X, 251E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WU0100XNursing Service ProvidersRegistered NurseUrology
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care