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General NPI Number Information
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NPI Number | 1366990830
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Entity Type | Organization
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Legal Business Name | JORDANIA PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 25111 PENNYROYAL DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34134
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Country | US
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Telephone | 630-740-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 25111 PENNYROYAL DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34134
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Country | US
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Telephone | 630-740-8375
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Fax |
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Authorized Official
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Title or Position | ONWER/PHYSICIAN
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Name | DR. NINA JORDANIA
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Credential | MD
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Telephone | 630-740-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | ME126750
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License Number State | FL
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