Provider Demographics
NPI:1770890055
Name:JORDAN, JEFFREY PAUL (NP-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36060 EUCLID AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4661
Mailing Address - Country:US
Mailing Address - Phone:440-375-8100
Mailing Address - Fax:
Practice Address - Street 1:36060 EUCLID AVE
Practice Address - Street 2:STE 107
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4661
Practice Address - Country:US
Practice Address - Phone:440-375-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11816-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3140667Medicaid