MEDICARE: DR. CRAIG JORDEN JR.

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	2084P0804X	Child & Adolescent Psychiatry Physician	11011653	FL
2	3104A0625X	Assisted Living Facility (Mental Illness)	11011653	FL
3	320800000X	Mental Illness Community Based Residential Treatment Facility	11011653	FL
4	363L00000X	Nurse Practitioner	11011653	FL
5	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	11011653	FL
6	364SP0812X	Community Psychiatric/Mental Health Clinical Nurse Specialist	11011653	FL
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11011653	FL

General Provider Information

NPI Number	:	1184218695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG JORDEN JR.

Provider Business Mailing Address
First Line	:	455 N US HIGHWAY 41 UNIT 1126
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33575-5246
Country	:	US
Telephone Number	:	813-364-4465
Fax Number	:	813-359-1886

Provider Business Practice Location Address
First Line	:	412 E MADISON ST STE 1012
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4618
Country	:	US
Telephone Number	:	813-364-4465
Fax Number	:	813-359-1886

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

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	03/31/2025

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