Healthcare Provider Details

I. General information

NPI: 1841828167
Provider Name (Legal Business Name): ANNIE SANABRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 SUNSHINE BLVD APT A
NAPLES FL
34116
US

IV. Provider business mailing address

2117 SUNSHINE BLVD APT A
NAPLES FL
34116
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-4295
  • Fax:
Mailing address:
  • Phone: 239-777-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberS51604496870-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: