Provider Demographics
NPI:1083669402
Name:JARDAS, NICHOLA K (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:K
Last Name:JARDAS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:315 E WARWICK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:899-463-6699
Mailing Address - Fax:989-466-2574
Practice Address - Street 1:26 E SAGINAW RD
Practice Address - Street 2:UNIT 4
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9293
Practice Address - Country:US
Practice Address - Phone:989-687-7812
Practice Address - Fax:989-687-7813
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-05-16
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Provider Licenses
StateLicense IDTaxonomies
MI5601004596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ67432Medicare UPIN