Individual
JASON A NYDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6117 GUNN HWY, TAMPA, FL 33625-4013
(813) 978-9700
(813) 558-6173
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
OS10894
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002462300
—
FL
01
—
1485V
BC/BS
FL
01
—
3357461
CIGNA
FL
01
—
PENDING
AVMED
FL
Enumeration date
10/08/2008
Last updated
01/27/2020
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