Healthcare Provider Details

I. General information

NPI: 1609780097
Provider Name (Legal Business Name): JORDYN HUNTER BRAZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4789 SW 148TH AVE STE 104
DAVIE FL
33330-2120
US

IV. Provider business mailing address

19101 SW 59TH ST
SOUTHWEST RANCHES FL
33332-1373
US

V. Phone/Fax

Practice location:
  • Phone: 305-342-9109
  • Fax:
Mailing address:
  • Phone: 305-342-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: