Provider Demographics
NPI:1184138364
Name:CORDIA, JOHN ODIA (PMHNP-APRN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ODIA
Last Name:CORDIA
Suffix:
Gender:M
Credentials:PMHNP-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4100
Mailing Address - Country:US
Mailing Address - Phone:754-204-5864
Mailing Address - Fax:786-916-6887
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:754-204-5864
Practice Address - Fax:786-916-6887
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9429559364SP0808X, 363LP0808X
TXAP140106363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102082100Medicaid