Healthcare Provider Details

I. General information

NPI: 1447100086
Provider Name (Legal Business Name): JORDAN CIRINCIONE MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 PLATT ST
MELBOURNE FL
32901-4546
US

IV. Provider business mailing address

PO BOX 120694
MELBOURNE FL
32912-0694
US

V. Phone/Fax

Practice location:
  • Phone: 321-209-1071
  • Fax: 321-256-6424
Mailing address:
  • Phone: 321-209-1071
  • Fax: 321-256-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number20025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: