Provider Demographics
NPI:1134475627
Name:SIDHU, KANWALJIT K (APRN)
Entity Type:Individual
Prefix:
First Name:KANWALJIT
Middle Name:K
Last Name:SIDHU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 TAMPA RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3130
Mailing Address - Country:US
Mailing Address - Phone:630-849-8756
Mailing Address - Fax:
Practice Address - Street 1:2595 TAMPA RD STE C
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3130
Practice Address - Country:US
Practice Address - Phone:630-849-8756
Practice Address - Fax:727-382-1382
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9438337363LF0000X
FL9438337363LF0000X
FLRN9438337363LP0808X
FLARNP94383337363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health