Provider Demographics
NPI:1619371937
Name:DECKER, JONATHAN WRIGHT (PHD, ARNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WRIGHT
Last Name:DECKER
Suffix:
Gender:M
Credentials:PHD, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163333
Mailing Address - Street 2:UCF STUDENT DEVELOPMENT AND ENROLLMENT SERVICES
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-3333
Mailing Address - Country:US
Mailing Address - Phone:407-823-2701
Mailing Address - Fax:407-823-2099
Practice Address - Street 1:4098 LIBRA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-3333
Practice Address - Country:US
Practice Address - Phone:407-823-2701
Practice Address - Fax:407-823-2099
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3056442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily