Individual
MRS. JANE LOUISE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-PP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1053165
GA
363LF0000X
Family Nurse Practitioner
201608781NPPP
OR
363LF0000X
Family Nurse Practitioner
ARNP9296651
FL
363LF0000X
Family Nurse Practitioner
Primary
CNP191103
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001328700
—
FL
01
—
CJ243Z
MEDICARE PTAN
FL
Enumeration date
03/09/2007
Last updated
07/10/2019
Update your record
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