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Individual

DR. NINA T JORDANIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6801 PORTO FINO CIR, STE 1, FORT MYERS, FL 33912-4344
(239) 225-0874
(239) 225-1465
Mailing address
25111 PENNYROYAL DR, STE 1, BONITA SPRINGS, FL 34134-7944
(630) 740-8375
(630) 740-8375

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036107234
IL
2084P0800X
Psychiatry Physician
ME126750
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0222075
BLUE CROSS GROUP
IL
01
036107234
STATE LICENSE
IL
05
036107234
IL
01
1033149844
CDPG NPI
IL
01
CA4748
MEDICARE RAILROAD (GROUP)
01
P00924097
MEDICARE RAILROAD (PROVIDER)
Enumeration date
06/24/2005
Last updated
03/20/2017
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