Basic Information
| Provider Information | |||||||||
| NPI: | 1609206853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., N.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1341 RIVERBROOK DR | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370763570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153424660 | ||||||||
| FaxNumber: | 6153424662 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 SAWGRASS CORPORATE PKWY | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2013 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 18660 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 163W00000X | 183833 | TN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.