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NPI Code Detail

MEDICARE: MARIAH JADE FORD

MEDICARE: MARIAH JADE FORD
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
1363A00000XPhysician AssistantPA9116401FL

General Provider Information

NPI Number : 1326769803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH JADE FORD
Provider Business Mailing Address
First Line : PO BOX 23329
Second Line :
City : NEW YORK
State : NY
Zip : 10087-3329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1005 E BOYER ST
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-5501
Country : US
Telephone Number : 727-934-7638
Fax Number : 727-944-4052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2022
Last Update Date : 04/08/2026

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Directions to “ MARIAH JADE FORD ” Practice Location

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