Healthcare Provider Details

I. General information

NPI: 1740197169
Provider Name (Legal Business Name): JORDAN DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 S JOG RD STE 303
DELRAY BEACH FL
33446-1249
US

IV. Provider business mailing address

150 DORSET D
BOCA RATON FL
33434-3012
US

V. Phone/Fax

Practice location:
  • Phone: 561-774-8225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: