Healthcare Provider Details

I. General information

NPI: 1972412062
Provider Name (Legal Business Name): SANDRA SWIATKIEWICZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HOLDERNESS DR
LONGWOOD FL
32779-5732
US

IV. Provider business mailing address

127 HOLDERNESS DR
LONGWOOD FL
32779-5732
US

V. Phone/Fax

Practice location:
  • Phone: 321-503-9055
  • Fax:
Mailing address:
  • Phone: 321-503-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9567375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: