Healthcare Provider Details

I. General information

NPI: 1891344479
Provider Name (Legal Business Name): JORDYN MARIAH HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5579 LIBERTY LN
LOXAHATCHEE FL
33470-7072
US

IV. Provider business mailing address

2211 NW FEDERAL HWY APT 1202
STUART FL
34994-9388
US

V. Phone/Fax

Practice location:
  • Phone: 561-292-0233
  • Fax:
Mailing address:
  • Phone: 760-486-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: