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NPI Code Detail

MEDICARE: JORDAN MACKENZIE MINAYA

MEDICARE: JORDAN MACKENZIE MINAYA
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
1106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1891418877
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MACKENZIE MINAYA
Provider Business Mailing Address
First Line : 13300 ATLANTIC BLVD APT 1416
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32225-6142
Country : US
Telephone Number : 813-570-3085
Fax Number :
Provider Business Practice Location Address
First Line : 7441 114TH AVE STE 604
Second Line :
City : LARGO
State : FL
Zip : 33773-5124
Country : US
Telephone Number : 727-492-5369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2022
Last Update Date : 05/06/2026

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Directions to “ JORDAN MACKENZIE MINAYA ” Practice Location

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