Healthcare Provider Details

I. General information

NPI: 1871562462
Provider Name (Legal Business Name): SANDI P THIBODEAU CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-6500
US

IV. Provider business mailing address

PO BOX 1626
OCALA FL
34478-1626
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone: 352-873-0516
  • Fax: 352-873-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2862282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: