MEDICARE: RENEE R JORDAN

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	251C00000X	Developmentally Disabled Services Day Training Agency		FL
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114397130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE R JORDAN

Provider Business Mailing Address
First Line	:	2281 OSHKOSH CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5258
Country	:	US
Telephone Number	:	407-451-0245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2281 OSHKOSH CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5258
Country	:	US
Telephone Number	:	407-451-0245
Fax Number	:

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

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	05/26/2020

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Directions to “ RENEE R JORDAN ” Practice Location

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