Provider Demographics
NPI:1285003830
Name:NEUHARDT, SYDNEY KALIN (MSN, CPNP-PC, ARNP)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:KALIN
Last Name:NEUHARDT
Suffix:
Gender:F
Credentials:MSN, CPNP-PC, ARNP
Other - Prefix:MS
Other - First Name:SYDNEY
Other - Middle Name:KALIN
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CPNP-PC, ARNP
Mailing Address - Street 1:19 ASHFORD LAKES DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-316-0813
Mailing Address - Fax:386-673-2760
Practice Address - Street 1:725 W. GRANADA BLVD. STE 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-373-2770
Practice Address - Fax:386-673-2760
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9369636363L00000X
FLAPRN9369636363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015872100Medicaid