Active NPI
Jordan Nelsen, PT
- Physical Therapist
- Fleming Island, FL
National Provider Identifier
1811386162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT30004
- Practice address
- 1851 Golden Eagle Way
Suite 43
Fleming Island, FL 32003-4333 - Phone
- (904) 374-1414
- Fax
- (877) 736-3470
- NPI assigned
- Jan 9, 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT30004 | FL | Primary |
Addresses
Primary practice location
1851 Golden Eagle Way
Suite 43
Fleming Island, FL 32003-4333
Mailing address
1851 Golden Eagle Way
Suite 43
Fleming Island, FL 32003-4333
Phone (904) 374-1414
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420761600000",
"number": "1811386162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1851 GOLDEN EAGLE WAY",
"address_2": "SUITE 43",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320034333",
"telephone_number": "904-374-1414",
"fax_number": "877-736-3470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1851 GOLDEN EAGLE WAY",
"address_2": "SUITE 43",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320034333",
"telephone_number": "904-374-1414",
"fax_number": "877-736-3470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSEN",
"first_name": "JORDAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-09",
"last_updated": "2015-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT30004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fleming Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.