Healthcare Provider Details

I. General information

NPI: 1164960340
Provider Name (Legal Business Name): CHELSEA KIDD P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST STE 203
SARASOTA FL
34239-3516
US

IV. Provider business mailing address

1950 ARLINGTON ST STE 203
SARASOTA FL
34239-3516
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-6331
  • Fax: 941-379-5443
Mailing address:
  • Phone: 941-379-6331
  • Fax: 941-379-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005667
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: