Healthcare Provider Details

I. General information

NPI: 1831864883
Provider Name (Legal Business Name): SANDRA ANN TIERNEY KAMHOOT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3651
US

IV. Provider business mailing address

4202 SW 82ND TER
GAINESVILLE FL
32608-3651
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9475
  • Fax:
Mailing address:
  • Phone: 352-514-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014521
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11014521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: