Provider Demographics
NPI:1427488360
Name:SEREDA, JESSIE BARDIN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:BARDIN
Last Name:SEREDA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JESSIE
Other - Middle Name:L
Other - Last Name:BARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-824-8294
Mailing Address - Fax:727-824-3132
Practice Address - Street 1:620 10TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8274
Practice Address - Fax:727-824-8293
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308668363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010149000Medicaid
FL010149000Medicaid