Provider Demographics
NPI:1083340764
Name:BARLAGE, JORDYNN SURAYA
Entity Type:Individual
Prefix:MS
First Name:JORDYNN
Middle Name:SURAYA
Last Name:BARLAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDYNN
Other - Middle Name:SURAYA
Other - Last Name:ROMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1357 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6136
Mailing Address - Country:US
Mailing Address - Phone:443-977-8602
Mailing Address - Fax:
Practice Address - Street 1:841 JIMMY ANN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4583
Practice Address - Country:US
Practice Address - Phone:386-506-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator