Provider Demographics
NPI:1073096269
Name:JORDAN, TAMIKO
Entity Type:Individual
Prefix:
First Name:TAMIKO
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 N MILITARY TRL STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-7430
Mailing Address - Country:US
Mailing Address - Phone:561-244-9499
Mailing Address - Fax:561-345-3800
Practice Address - Street 1:7731 N MILITARY TRL STE 4
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7430
Practice Address - Country:US
Practice Address - Phone:561-244-9499
Practice Address - Fax:561-345-3800
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2869101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor