Healthcare Provider Details

I. General information

NPI: 1447009485
Provider Name (Legal Business Name): JACOB JOSEPH HEZGHIAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GRIFFIN RD STE 205
FORT LAUDERDALE FL
33312-6900
US

IV. Provider business mailing address

3201 GRIFFIN RD STE 205
FORT LAUDERDALE FL
33312-6900
US

V. Phone/Fax

Practice location:
  • Phone: 305-647-3660
  • Fax: 305-647-3665
Mailing address:
  • Phone: 305-647-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11039537
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF353871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: