Provider Demographics
NPI:1437548302
Name:MARDESICH, NAOMI KAJI (ARNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:KAJI
Last Name:MARDESICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 MACLAY BLVD S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1277
Mailing Address - Country:US
Mailing Address - Phone:850-877-1162
Mailing Address - Fax:850-701-2535
Practice Address - Street 1:3606 MACLAY BLVD S
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1277
Practice Address - Country:US
Practice Address - Phone:850-877-1162
Practice Address - Fax:850-701-2535
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9399027363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics