Healthcare Provider Details

I. General information

NPI: 1811181985
Provider Name (Legal Business Name): SANDRA PAQUINGAN KLOMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA PAQUINGAN

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PARKWAY #10C MEDICAL PROFESSIONAL AGENCY
PENSACOLA FL
32514
US

IV. Provider business mailing address

P.O. BOX 893 MEDICAL PROFESSIONAL AGENCY
MILTON FL
32572-0893
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-2948
  • Fax: 850-626-2734
Mailing address:
  • Phone: 850-623-2948
  • Fax: 850-626-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3358402
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3358402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: