Individual
ERIC A JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1350 HICKORY ST, SUITE 102, MELBOURNE, FL 32901-3224
(321) 434-3455
(321) 434-3456
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3455
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9107646
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010029600
—
FL
01
—
HP736Y
MEDICARE
FL
Enumeration date
11/08/2013
Last updated
04/09/2019
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