NPI | 1972199644 |
---|---|
Former Name | JORDAN NICOLE PATRICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 28834) |
Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: TN 188484) |
Enumeration Date | 2020-12-17 |
Last Update Date | 2021-02-06 |