MEDICARE: JORDAN MACOMBER

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	BACB1108322	FL

General Provider Information

NPI Number	:	1043179591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MACOMBER

Provider Business Mailing Address
First Line	:	1012 KNECHT RD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3936
Country	:	US
Telephone Number	:	321-557-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 KNECHT RD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3936
Country	:	US
Telephone Number	:	321-557-6443
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	06/25/2026

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Directions to “ JORDAN MACOMBER ” Practice Location

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