Healthcare Provider Details

I. General information

NPI: 1124484316
Provider Name (Legal Business Name): SANDRA SUN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 TRUMAN AVE
KEY WEST FL
33040-7252
US

IV. Provider business mailing address

1308 PETRONIA ST
KEY WEST FL
33040-7235
US

V. Phone/Fax

Practice location:
  • Phone: 305-791-3003
  • Fax: 305-294-8388
Mailing address:
  • Phone: 305-393-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9338059
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9338059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: