Provider Demographics
NPI:1558183145
Name:PAPPAS, MORDAN ALEXANDRA
Entity type:Individual
Prefix:
First Name:MORDAN
Middle Name:ALEXANDRA
Last Name:PAPPAS
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 1:28082 SOSTA LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BONITA SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8020
Mailing Address - Country:US
Mailing Address - Phone:215-317-2961
Mailing Address - Fax:
Practice Address - Street 1:28082 SOSTA LN UNIT 2
Practice Address - Street 2:
Practice Address - City:BONITA SPGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8020
Practice Address - Country:US
Practice Address - Phone:215-317-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP277189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily