Active NPI
Jordan Kudlak
- Critical Care Medicine Registered Nurse
- Jacksonville, FL
National Provider Identifier
1013573369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Registered Nurse
- License
- 238832
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 238832 | SC | MD | Critical 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.