Healthcare Provider Details

I. General information

NPI: 1396830352
Provider Name (Legal Business Name): TEENA YVONNE SANDERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 5TH AVE STE C
INDIALANTIC FL
32903-3167
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 321-821-4882
  • Fax:
Mailing address:
  • Phone: 904-697-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3178122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: