MEDICARE: JORDYN MARIAH HOLMES

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	235Z00000X	Speech-Language Pathologist	SZ12313	FL

General Provider Information

NPI Number	:	1891344479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDYN MARIAH HOLMES

Provider Business Mailing Address
First Line	:	2211 NW FEDERAL HWY APT 1202
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-9388
Country	:	US
Telephone Number	:	760-486-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2684 SW IMMANUEL DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-291-2179
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	01/26/2026

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Directions to “ JORDYN MARIAH HOLMES ” Practice Location

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