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General NPI Number Information
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NPI Number | 1245734409
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Entity Type | Individual
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Provider Name | JORDAN MARIE MINISH-PRON MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4700 BAYOU BLVD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32503-1901
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Country | US
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Telephone | 850-477-9253
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Fax | 850-494-9843
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Provider Business Mailing Address
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Address Line | 4700 BAYOU BLVD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32503-1901
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Country | US
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Telephone | 850-477-9253
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Fax | 850-494-9843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME168369
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License Number State | FL
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