Healthcare Provider Details

I. General information

NPI: 1366965089
Provider Name (Legal Business Name): JORDAN TERRELL STRIGGLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 NW 5TH TERR
POMPANO BEACH FL
33060
US

IV. Provider business mailing address

1871 NW 5TH TER
POMPANO BEACH FL
33060-5105
US

V. Phone/Fax

Practice location:
  • Phone: 954-899-8119
  • Fax:
Mailing address:
  • Phone: 954-899-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: