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NPI Code Detail

MEDICARE: BROOKLYNNE PAIGE JORDAN

MEDICARE: BROOKLYNNE PAIGE JORDAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician106S00000XFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457024739
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKLYNNE PAIGE JORDAN
Provider Business Mailing Address
First Line : 2601 SE EMMETT RD
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34952-5214
Country : US
Telephone Number : 239-233-5098
Fax Number :
Provider Business Practice Location Address
First Line : 10272 S US HIGHWAY 1
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-5615
Country : US
Telephone Number : 772-872-6940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2021
Last Update Date : 01/25/2024

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Directions to “ BROOKLYNNE PAIGE JORDAN ” Practice Location

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