Provider Demographics
NPI:1083154694
Name:ECO, JOSE ELMO BACCAY (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE ELMO
Middle Name:BACCAY
Last Name:ECO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6607
Mailing Address - Country:US
Mailing Address - Phone:954-748-3039
Mailing Address - Fax:
Practice Address - Street 1:3505 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6607
Practice Address - Country:US
Practice Address - Phone:954-748-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3110802363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology