Provider Demographics
NPI:1427558956
Name:KHALSA, SATJIWAN KAUR (RN)
Entity Type:Individual
Prefix:
First Name:SATJIWAN
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 BAHIA SHORES RD
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-5206
Mailing Address - Country:US
Mailing Address - Phone:786-469-1781
Mailing Address - Fax:
Practice Address - Street 1:3000 41ST STREET OCEAN
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2373
Practice Address - Country:US
Practice Address - Phone:305-434-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse