Healthcare Provider Details

I. General information

NPI: 1225422660
Provider Name (Legal Business Name): SANDRA JEAN VANHORN MSN, AGCPNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WESTMORELAND DR
ORLANDO FL
32805-2258
US

IV. Provider business mailing address

101 S WESTMORELAND DR
ORLANDO FL
32805-2258
US

V. Phone/Fax

Practice location:
  • Phone: 407-863-9263
  • Fax: 407-836-7163
Mailing address:
  • Phone: 407-863-9263
  • Fax: 407-836-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 1758092
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP1758092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: