Provider Demographics
NPI:1770389660
Name:JORDAN, TYLER QUINN (EMT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:QUINN
Last Name:JORDAN
Suffix:
Gender:
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0517
Mailing Address - Country:US
Mailing Address - Phone:831-673-9255
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 517
Practice Address - Street 2:
Practice Address - City:SAN JUAN BAUTISTA
Practice Address - State:CA
Practice Address - Zip Code:95045-0517
Practice Address - Country:US
Practice Address - Phone:831-673-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE196203207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services