Provider Demographics
NPI:1366898587
Name:SPIEGEL, JORDYN AMY (FNP)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:AMY
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 WELLESLEY AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2044
Mailing Address - Country:US
Mailing Address - Phone:646-831-6693
Mailing Address - Fax:
Practice Address - Street 1:1332 WELLESLEY AVE
Practice Address - Street 2:APT 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2044
Practice Address - Country:US
Practice Address - Phone:646-831-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily