Healthcare Provider Details

I. General information

NPI: 1740005776
Provider Name (Legal Business Name): SANDRA JEAN GIUSTO RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 US 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

1612 OAK ARBOR LN
VALRICO FL
33596-7203
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-0000
  • Fax:
Mailing address:
  • Phone: 413-531-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9527093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: