MEDICARE: JORDAN HARNAGE RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013780246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HARNAGE RBT

Provider Business Mailing Address
First Line	:	6417 RUBIA CIR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2917
Country	:	US
Telephone Number	:	813-426-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	5628 36TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1914
Country	:	US
Telephone Number	:	727-424-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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Directions to “ JORDAN HARNAGE RBT” Practice Location

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