Organization
FOUNTAIN VALLEY HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUITA JORDAN FNP (OWNER)
(719) 271-2887
Entity
Organization
Contact information
Practice address
1259 LAKE PLAZA DR STE 270, COLORADO SPRINGS, CO 80906-3560
(719) 271-2887
Mailing address
10265 ROLLING RIDGE RD, COLORADO SPRINGS, CO 80925-9509
(719) 271-2887
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000205225
—
CO
Enumeration date
06/01/2022
Last updated
10/18/2022
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