Provider Demographics
NPI:1942671516
Name:SHERIDAN, KAREN ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 STANWOOD ST
Mailing Address - Street 2:PHILADELPHIA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2311
Mailing Address - Country:US
Mailing Address - Phone:215-776-1808
Mailing Address - Fax:
Practice Address - Street 1:716 STANWOOD ST
Practice Address - Street 2:PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2311
Practice Address - Country:US
Practice Address - Phone:215-776-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015154363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN608005OtherCOMMONWEALTH OF PENNSYLVANIA, STATE BOARD OF NURSING
PASP015154OtherCOMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF STATE, CERTIFIED NURSE PRACTITIONER
NJ26NR15403300OtherNEW JERSEY CONSUMER AFFAIRS
AG0415071OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS