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NPI Code Detail

MEDICARE: JORDAN ROBERSON PMHNP-BC

MEDICARE: JORDAN ROBERSON PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN9410928FL
2363L00000XNurse Practitioner9410928FL

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 : 1669965000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN ROBERSON PMHNP-BC
Provider Business Mailing Address
First Line : 1737 N CLYDE MORRIS BLVD STE 300
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5533
Country : US
Telephone Number : 386-262-1627
Fax Number :
Provider Business Practice Location Address
First Line : 1737 N CLYDE MORRIS BLVD STE 300
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5533
Country : US
Telephone Number : 386-262-1627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2018
Last Update Date : 04/07/2026

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Directions to “ JORDAN ROBERSON PMHNP-BC” Practice Location

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