Healthcare Provider Details

I. General information

NPI: 1184218695
Provider Name (Legal Business Name): DR. CRAIG JORDEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E MADISON ST STE 1012
TAMPA FL
33602-4618
US

IV. Provider business mailing address

455 N US HIGHWAY 41 UNIT 1126
RUSKIN FL
33575-5246
US

V. Phone/Fax

Practice location:
  • Phone: 813-364-4465
  • Fax: 813-359-1886
Mailing address:
  • Phone: 813-364-4465
  • Fax: 813-359-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11011653
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number11011653
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number11011653
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11011653
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number11011653
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number11011653
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11011653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: