MEDICARE: ROBIN L JORDAN LCSW

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
1	1041C0700X	Clinical Social Worker	SW22229	FL
2	1041C0700X	Clinical Social Worker	34008227A	IN
3	1041C0700X	Clinical Social Worker	253255	KY

General Provider Information

NPI Number	:	1568836997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN L JORDAN LCSW

Provider Business Mailing Address
First Line	:	5 MIRACLE STRIP LOOP STE 15
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-8410
Country	:	US
Telephone Number	:	850-235-8495
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 MIRACLE STRIP LOOP STE 15
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-8410
Country	:	US
Telephone Number	:	850-235-8495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	06/20/2025

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