MEDICARE: SAJID KHAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11001857	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346701018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAJID KHAN APRN

Provider Business Mailing Address
First Line	:	5012 OLDE KERRY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-4704
Country	:	US
Telephone Number	:	407-545-1673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LUCIEN WAY STE 200
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7003
Country	:	US
Telephone Number	:	877-868-4827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	04/23/2021

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