Provider Demographics
NPI:1942536321
Name:ADI, NADIMA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NADIMA
Middle Name:
Last Name:ADI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7379 W DESCHUTES AVE STE 100
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7900
Practice Address - Country:US
Practice Address - Phone:509-987-1800
Practice Address - Fax:509-987-1808
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120212363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500628169Medicaid
WA6639748OtherCIGNA
WAG8966886OtherMEDICARE
WA0266055OtherLABOR & INDUSTRIES
WA1942536321Medicaid
WA9329810OtherAETNA
WA1942536321Medicaid