Provider Demographics
NPI:1457063026
Name:KHAN, NOORAH (ARNP)
Entity type:Individual
Prefix:
First Name:NOORAH
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4884 HIBBS GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4449
Mailing Address - Country:US
Mailing Address - Phone:305-965-3893
Mailing Address - Fax:
Practice Address - Street 1:4884 HIBBS GROVE WAY
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-4449
Practice Address - Country:US
Practice Address - Phone:305-965-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily