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NPI Code Detail

MEDICARE: JORDAN HOLT BCBA

MEDICARE: JORDAN HOLT BCBA
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
1103K00000XBehavior Analyst1-09-5895FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851620371
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN HOLT BCBA
Provider Business Mailing Address
First Line : 2138 SANDRIDGE CIR
Second Line :
City : EUSTIS
State : FL
Zip : 32726-4486
Country : US
Telephone Number : 478-954-4278
Fax Number :
Provider Business Practice Location Address
First Line : 2138 SANDRIDGE CIR
Second Line :
City : EUSTIS
State : FL
Zip : 32726-4486
Country : US
Telephone Number : 478-954-4278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2009
Last Update Date : 07/21/2023

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