Healthcare Provider Details

I. General information

NPI: 1346144813
Provider Name (Legal Business Name): JORDAN PRESCOTT MENDEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SUN N LAKE BLVD
SEBRING FL
33872-1986
US

IV. Provider business mailing address

5700 COLUMBUS BLVD
SEBRING FL
33872-9034
US

V. Phone/Fax

Practice location:
  • Phone: 863-314-4466
  • Fax:
Mailing address:
  • Phone: 786-877-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9695267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: