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NPI Code Detail

MEDICARE: JORDAN MICHAEL LAVENDER

MEDICARE: JORDAN MICHAEL LAVENDER
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1790636314
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MICHAEL LAVENDER
Provider Business Mailing Address
First Line : 800 OLD BRIDGE RD UNIT 1
Second Line :
City : SAINT JOHNS
State : FL
Zip : 32259-4872
Country : US
Telephone Number : 904-803-3115
Fax Number :
Provider Business Practice Location Address
First Line : 45 ALABAMA AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-2677
Country : US
Telephone Number : 904-420-2304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ JORDAN MICHAEL LAVENDER ” Practice Location

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