MEDICARE: JOHN ODIA CORDIA PMHNP-APRN

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	APRN9429559	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9429559	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP140106	TX

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	:	1184138364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ODIA CORDIA PMHNP-APRN

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

Provider Business Practice Location Address
First Line	:	8910 MIRAMAR PKWY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-4100
Country	:	US
Telephone Number	:	754-204-5864
Fax Number	:	786-916-6887

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

Provider Enumeration Date	:	11/26/2017
Last Update Date	:	05/18/2021

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