MEDICARE: EZECHIEL JEAN

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	311ZA0620X	Adult Care Home Facility	6907145	FL

General Provider Information

NPI Number	:	1750260568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZECHIEL JEAN

Provider Business Mailing Address
First Line	:	51 ALEGRO DR
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-1745
Country	:	US
Telephone Number	:	561-513-7382
Fax Number	:	850-257-8096

Provider Business Practice Location Address
First Line	:	51 ALEGRO DR
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-1745
Country	:	US
Telephone Number	:	561-513-7382
Fax Number	:	850-257-8096

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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Directions to “ EZECHIEL JEAN ” Practice Location

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