Healthcare Provider Details

I. General information

NPI: 1235690868
Provider Name (Legal Business Name): BENJAMIN FORBES DECKOFF CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

16978 75TH PL N
LOXAHATCHEE FL
33470-5810
US

V. Phone/Fax

Practice location:
  • Phone: 561-263-2234
  • Fax:
Mailing address:
  • Phone: 561-398-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11003013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9292879
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A10879
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: