Healthcare Provider Details

I. General information

NPI: 1316878184
Provider Name (Legal Business Name): NATHANAEL JAMES GORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 PICKFORD CIR
APOPKA FL
32703-3369
US

IV. Provider business mailing address

2326 PICKFORD CIR
APOPKA FL
32703-3369
US

V. Phone/Fax

Practice location:
  • Phone: 954-859-8000
  • Fax:
Mailing address:
  • Phone: 954-859-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: