Individual provider Active NPI

Jordan Kudlak

  • Critical Care Medicine Registered Nurse
  • Jacksonville, FL
National Provider Identifier
1013573369
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Registered NurseTaxonomy code 163WC0200X
License
238832 Issued in SC
Practice address
14550 Old Saint Augustine Rd
Jacksonville, FL 32258-2460
Phone
(904) 271-6000
NPI assigned
May 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 238832 SC Primary

Addresses

Primary practice location

14550 Old Saint Augustine Rd
Jacksonville, FL 32258-2460

Mailing address

1306 Brighton Ave
Myrtle Beach, SC 29588-5411

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-2300

Other practice location 2

809 82nd Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 692-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
238832SCMDCritical Care Medicine Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1013573369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 BRIGHTON AVE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295885411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14550 OLD SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582460",
            "telephone_number": "904-271-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-2300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "809 82nd Pkwy",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295724607",
            "country_code": "US",
            "telephone_number": "843-692-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUDLAK",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "SC",
            "license": "238832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.