Provider Demographics
NPI:1659543171
Name:LIA NARDONE MD PA
Entity Type:Organization
Organization Name:LIA NARDONE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-820-0505
Mailing Address - Street 1:145 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3015
Mailing Address - Country:US
Mailing Address - Phone:727-820-0505
Mailing Address - Fax:
Practice Address - Street 1:145 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3015
Practice Address - Country:US
Practice Address - Phone:727-820-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL655832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25339Medicare PIN