Individual
TINA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3 RICHLAND MEDICAL PARK DR STE 120, COLUMBIA, SC 29203-6850
(803) 434-8866
(803) 933-3049
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22875
SC
363L00000X
Nurse Practitioner
APRN9409068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016957700
—
FL
01
—
IQ167Z
MEDICARE
FL
Enumeration date
03/15/2016
Last updated
09/20/2019
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