Provider Demographics
NPI:1144876145
Name:FARNUM, JORDAIJA DAVISIA
Entity type:Individual
Prefix:
First Name:JORDAIJA
Middle Name:DAVISIA
Last Name:FARNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-3056
Mailing Address - Country:US
Mailing Address - Phone:941-920-2848
Mailing Address - Fax:941-708-3193
Practice Address - Street 1:2510 11TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-3056
Practice Address - Country:US
Practice Address - Phone:941-920-2848
Practice Address - Fax:941-708-3193
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide