Healthcare Provider Details

I. General information

NPI: 1801250097
Provider Name (Legal Business Name): JORDAN CULPEPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 02/09/2024
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18288 N US HIGHWAY 41
LUTZ FL
33549-4400
US

IV. Provider business mailing address

166 FAIRMONT DR
SPRING HILL FL
34609-2048
US

V. Phone/Fax

Practice location:
  • Phone: 813-527-9638
  • Fax:
Mailing address:
  • Phone: 407-280-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-20-11069
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11069
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-21431
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-70859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: