Individual
TYNETTE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
708 N.W WILSON ST., LAKE CITY, FL 32055
(407) 680-8483
Mailing address
708 NW WILSON ST, LAKE CITY, FL 32055-1808
(407) 680-8483
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/09/2014
Last updated
05/09/2014
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