Provider Demographics
NPI:1083603146
Name:HANDZA, JASON M (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:HANDZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-5605
Mailing Address - Country:US
Mailing Address - Phone:727-365-7376
Mailing Address - Fax:
Practice Address - Street 1:2055 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-862-3090
Practice Address - Fax:727-862-3023
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8933207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270892200Medicaid
FL270892201Medicaid
FL270892201Medicaid
FL37827YMedicare ID - Type UnspecifiedPROVIDER #
FL270892200Medicaid