Healthcare Provider Details

I. General information

NPI: 1093155384
Provider Name (Legal Business Name): DEMARIS SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W 1ST ST
SANFORD FL
32771-1617
US

IV. Provider business mailing address

1621 W 1ST ST
SANFORD FL
32771-1617
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-4431
  • Fax: 407-322-4448
Mailing address:
  • Phone: 407-322-4431
  • Fax: 407-322-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9379561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: