Healthcare Provider Details

I. General information

NPI: 1114736055
Provider Name (Legal Business Name): FRANKLIN CORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: