Healthcare Provider Details

I. General information

NPI: 1083669402
Provider Name (Legal Business Name): NICHOLA K JARDAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E SAGINAW RD UNIT 4
SANFORD MI
48657-9293
US

IV. Provider business mailing address

315 E WARWICK DR STE 3
ALMA MI
48801-1083
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-7812
  • Fax: 989-687-7813
Mailing address:
  • Phone: 899-463-6699
  • Fax: 989-466-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004596
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: