MEDICARE: NAOMI KAJI MARDESICH ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP9399027	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437548302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI KAJI MARDESICH ARNP

Provider Business Mailing Address
First Line	:	3606 MACLAY BLVD S
Second Line	:	SUITE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1277
Country	:	US
Telephone Number	:	850-877-1162
Fax Number	:	850-701-2535

Provider Business Practice Location Address
First Line	:	3606 MACLAY BLVD S
Second Line	:	SUITE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1277
Country	:	US
Telephone Number	:	850-877-1162
Fax Number	:	850-701-2535

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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