Provider Demographics
NPI:1629866827
Name:JONAS, EDDY (SA-C)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:JONAS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PETER PAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7507
Mailing Address - Country:US
Mailing Address - Phone:321-390-6232
Mailing Address - Fax:321-390-6232
Practice Address - Street 1:425 PETER PAN BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7507
Practice Address - Country:US
Practice Address - Phone:321-390-6232
Practice Address - Fax:321-390-6232
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-230246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant