Active NPI
Nicole Michelle Jordan
- Clinical Social Worker
- Capitola, CA
National Provider Identifier
1528438769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 35806
- Practice address
- 1350 41St Ave
Suite 201
Capitola, CA 95010-3906 - Phone
- (831) 737-7450
- NPI assigned
- Sep 30, 2015
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 35806 | CA | Primary |
Addresses
Primary practice location
1350 41St Ave
Suite 201
Capitola, CA 95010-3906
Mailing address
101 Ladera Dr
Santa Cruz, CA 95060-5210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912278003 | Other | CA | DEPARTMENT OF VETERANS AFFAIRS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443571200000",
"number": "1528438769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 LADERA DR",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950605210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 41ST AVE",
"address_2": "SUITE 201",
"city": "CAPITOLA",
"state": "CA",
"postal_code": "950103906",
"telephone_number": "831-737-7450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "NICOLE",
"middle_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-30",
"last_updated": "2015-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "35806",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF VETERANS AFFAIRS",
"identifier": "1912278003",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Capitola, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.