Individual
JORDAN ADAM CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12880 COMMODITY PL, TAMPA, FL 33626-3101
(813) 343-5500
(866) 462-7445
Mailing address
PO BOX 21686, TAMPA, FL 33622-1686
(813) 343-5500
(866) 462-7445
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
002789
CT
363AS0400X
Surgical Physician Assistant
Primary
PA9107357
FL
Other
Enumeration date
08/07/2012
Last updated
10/10/2013
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