Provider Demographics
NPI:1548460165
Name:CARDON, JOSEPH ERIC (AA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ERIC
Last Name:CARDON
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 W HIBISCUS BLVD
Mailing Address - Street 2:STE215
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2620
Mailing Address - Country:US
Mailing Address - Phone:321-837-3820
Mailing Address - Fax:321-837-3654
Practice Address - Street 1:1775 W HIBISCUS BLVD
Practice Address - Street 2:STE215
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2620
Practice Address - Country:US
Practice Address - Phone:321-837-3820
Practice Address - Fax:321-837-3654
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005181367H00000X
FLAA25367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA299968508AMedicaid