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General NPI Number Information
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NPI Number | 1447050950
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Entity Type | Individual
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Provider Name | JORDAN ZACHARY PULLIAM BS
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 40347 US HIGHWAY 19 N
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4840
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Country | US
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Telephone | 727-330-8932
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Fax | 727-772-8212
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Provider Business Mailing Address
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Address Line | 10328 TURKEY OAK DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5840
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Country | US
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Telephone | 813-720-0581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-419376
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License Number State | FL
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