Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003328717 |
---|---|
Provider Name | Alexandra E Jordan |
First Address | Homestead, FL 33032-3113 |
Second Address | Homestead, FL 33032-3113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024344000 | (05) | FL |