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Individual
KENNETH EDWARD NIDA
Active
Individual
KENNETH EDWARD NIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9107756
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014260400
—
FL
01
—
1659525681
TRICARE
FL
01
—
Y0Q8M
BCBS
FL
Enumeration date
11/04/2008
Last updated
06/08/2015
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