Provider Demographics
NPI:1174116818
Name:GORDON THOMPSON, JESSICA GORDON
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GORDON
Last Name:GORDON THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4786 PIEDMONT CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4306
Mailing Address - Country:US
Mailing Address - Phone:407-486-0758
Mailing Address - Fax:
Practice Address - Street 1:7915 TANBIER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8746
Practice Address - Country:US
Practice Address - Phone:140-748-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9416590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse