Provider Demographics
NPI:1932892197
Name:ELLIOTT, JORDAN F (APRN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:F
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:FRISBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6981 GREYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2310
Mailing Address - Country:US
Mailing Address - Phone:239-209-7658
Mailing Address - Fax:
Practice Address - Street 1:4771 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1317
Practice Address - Country:US
Practice Address - Phone:239-343-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9514235163W00000X
FL11026749363L00000X
FLAPRN11026749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118448900Medicaid