Healthcare Provider Details

I. General information

NPI: 1881442762
Provider Name (Legal Business Name): SANDRA P MOGOLLON SAKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 DELLA DR STE H
ORLANDO FL
32819-5106
US

IV. Provider business mailing address

7243 DELLA DR STE H
ORLANDO FL
32819-5106
US

V. Phone/Fax

Practice location:
  • Phone: 407-381-7336
  • Fax: 321-203-4668
Mailing address:
  • Phone: 407-381-7336
  • Fax: 321-203-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11031685
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN11031685
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: