Individual
MRS. SAMANTHA M JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A-C, MMS
Contact information
Practice address
8580 SCARBOROUGH DR, SUITE 225, COLORADO SPRINGS, CO 80920-7583
(719) 531-5400
(719) 531-9545
Mailing address
8580 SCARBOROUGH DR, SUITE 225, COLORADO SPRINGS, CO 80920-7583
(719) 531-5400
(719) 531-9545
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2544
AZ
363A00000X
Physician Assistant
Primary
PA.0003956
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2544
STATE LICENSE
AZ
01
—
2544
AZ STATE LICENSE
—
Enumeration date
09/20/2006
Last updated
11/24/2014
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