Provider Demographics
NPI:1023723566
Name:ABECASIS, JORDAN (MBE)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:ABECASIS
Suffix:
Gender:M
Credentials:MBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12263 NW 49TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3461
Mailing Address - Country:US
Mailing Address - Phone:954-288-1614
Mailing Address - Fax:
Practice Address - Street 1:12263 NW 49TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3461
Practice Address - Country:US
Practice Address - Phone:954-288-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies