Healthcare Provider Details

I. General information

NPI: 1376199893
Provider Name (Legal Business Name): JORDAN BRECHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

IV. Provider business mailing address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0833
  • Fax: 352-394-0367
Mailing address:
  • Phone: 352-394-0833
  • Fax: 352-394-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113807
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9113807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: