Individual
JENNIFER GRACE TORDILLA WADIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-8277
Mailing address
13000 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4745
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME 100441
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09174
BLUE CROSS BLUE SHIELD
FL
05
—
280073000
—
FL
Enumeration date
07/30/2007
Last updated
02/03/2021
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