Provider Demographics
NPI:1902469182
Name:SHERIDAN, JANICE R (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:R
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:R
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26067
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0067
Mailing Address - Country:US
Mailing Address - Phone:239-624-0400
Mailing Address - Fax:
Practice Address - Street 1:15420 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-3917
Practice Address - Country:US
Practice Address - Phone:239-624-0600
Practice Address - Fax:239-624-0601
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0ALWOOtherBCBS
FL111721800Medicaid