Healthcare Provider Details

I. General information

NPI: 1316909351
Provider Name (Legal Business Name): SANDY LEIGH GAGLIARDI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDY LEIGH LEGGETT

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 N MILLS AVE
ORLANDO FL
32803-1853
US

IV. Provider business mailing address

PO BOX 740209 DEPT 40039
ATLANTA GA
30374-0209
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-7438
  • Fax: 407-896-7440
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9177529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: