Provider Demographics
NPI:1043979982
Name:JORDAN, ALLEN GENE III (PA-C)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:GENE
Last Name:JORDAN
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2723
Mailing Address - Country:US
Mailing Address - Phone:407-355-3120
Mailing Address - Fax:407-355-3119
Practice Address - Street 1:5979 VINELAND RD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7860
Practice Address - Country:US
Practice Address - Phone:407-355-3120
Practice Address - Fax:407-355-3119
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant