Provider Demographics
NPI:1710510813
Name:KHALIQ, NOSHABA (PA)
Entity Type:Individual
Prefix:
First Name:NOSHABA
Middle Name:
Last Name:KHALIQ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:200 HEALTHCARE WAY UNIT 103
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3670
Practice Address - Country:US
Practice Address - Phone:941-261-0160
Practice Address - Fax:941-261-0165
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9112878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant