1750685764 NPI number — MS. JORDAN MARIE MAGIERA A.R.N.P.

Table of content: MS. JORDAN MARIE MAGIERA A.R.N.P. (NPI 1750685764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750685764 NPI number — MS. JORDAN MARIE MAGIERA A.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGIERA
Provider First Name:
JORDAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRAZIER
Provider Other First Name:
JORDAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.R.N.P
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750685764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13241 BARTRAM PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32258-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-224-5437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13241 BARTRAM PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32258-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-224-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  ARNP 9277629 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004374400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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