MEDICARE: COCOA BEACH FAMILY MEDICINE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1457168254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCOA BEACH FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	1980 N ATLANTIC AVE STE 905
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-3277
Country	:	US
Telephone Number	:	321-342-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 N ATLANTIC AVE STE 905
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-3277
Country	:	US
Telephone Number	:	321-342-4948
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JORDAN LOFTIS
Credential	:	MD
Telephone Number	:	321-749-5566

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “COCOA BEACH FAMILY MEDICINE ” Practice Location

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