Healthcare Provider Details

I. General information

NPI: 1295671865
Provider Name (Legal Business Name): MARGARET JORDAN HEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKEBRIDGE PLAZA DR
ORMOND BEACH FL
32174-5157
US

IV. Provider business mailing address

400 LAKEBRIDGE PLAZA DR
ORMOND BEACH FL
32174-5157
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-9044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: