MEDICARE: MR. BENJAMIN FORBES DECKOFF CRNA, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APRN11003013	FL
2	163W00000X	Registered Nurse	RN9292879	FL
3	367500000X	Certified Registered Nurse Anesthetist	L6-0A10879	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN9292879	OTHER	FL	FLORIDA RN LICENSE
2	APRN11003013	OTHER	FL	FL APRN LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235690868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN FORBES DECKOFF CRNA, MSN

Provider Business Mailing Address
First Line	:	16978 75TH PL N
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-5810
Country	:	US
Telephone Number	:	561-398-5204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-263-2234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	01/07/2026

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