Healthcare Provider Details

I. General information

NPI: 1063407880
Provider Name (Legal Business Name): ROBERT C SANFORD ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 BELFORT RD SUITE 130
JACKSONVILLE FL
32256-6017
US

IV. Provider business mailing address

5220 BELFORT RD SUITE 130
JACKSONVILLE FL
32256-6017
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-3451
  • Fax: 904-446-3013
Mailing address:
  • Phone: 904-446-3451
  • Fax: 904-446-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9202171
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberARNP 9202171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: