Provider Demographics
NPI:1164246963
Name:JACOTIN, JORDANY (MD)
Entity type:Individual
Prefix:DR
First Name:JORDANY
Middle Name:
Last Name:JACOTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORDANY
Other - Middle Name:
Other - Last Name:JACOTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7726 WINEGARD RD STE 53
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7147
Mailing Address - Country:US
Mailing Address - Phone:407-908-5693
Mailing Address - Fax:407-641-2980
Practice Address - Street 1:7726 WINEGARD RD STE 53
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:407-908-5693
Practice Address - Fax:407-641-2980
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty