Individual
TRICIA FRACK JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(707) 776-3138
(703) 776-2623
Mailing address
3100 SPRING FOREST RD, SUITE 130, RALEIGH, NC 27616-2880
(919) 882-0705
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001162092
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024162092
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010385903
—
VA
05
—
0105051700
—
MD
Enumeration date
06/03/2006
Last updated
05/22/2014
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