Provider Demographics
NPI:1255173407
Name:KRUPA, SIDNEY (FNP-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:KRUPA
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6002
Mailing Address - Country:US
Mailing Address - Phone:678-416-0652
Mailing Address - Fax:
Practice Address - Street 1:1825 HIGHWAY 34 E STE 3400
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6433
Practice Address - Country:US
Practice Address - Phone:770-400-9588
Practice Address - Fax:470-400-3452
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN300116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1255173407Medicaid