1184138364 NPI number — JOHN ODIA CORDIA PMHNP-APRN

Table of content: JOHN ODIA CORDIA PMHNP-APRN (NPI 1184138364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184138364 NPI number — JOHN ODIA CORDIA PMHNP-APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDIA
Provider First Name:
JOHN
Provider Middle Name:
ODIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184138364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8910 MIRAMAR PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-204-5864
Provider Business Mailing Address Fax Number:
786-916-6887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8910 MIRAMAR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
754-204-5864
Provider Business Practice Location Address Fax Number:
786-916-6887
Provider Enumeration Date:
11/26/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  APRN9429559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN9429559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: AP140106 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102082100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".