Healthcare Provider Details

I. General information

NPI: 1407510654
Provider Name (Legal Business Name): DANIEL SANDOVAL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 BUCHANNAN DR
DAVENPORT FL
33837-3674
US

IV. Provider business mailing address

612 BUCHANNAN DR
DAVENPORT FL
33837-3674
US

V. Phone/Fax

Practice location:
  • Phone: 787-203-4789
  • Fax:
Mailing address:
  • Phone: 787-203-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11043867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: