Healthcare Provider Details

I. General information

NPI: 1972086841
Provider Name (Legal Business Name): KARISSA SANDERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E TWIGGS ST STE 103
TAMPA FL
33602-3925
US

IV. Provider business mailing address

9929 IVORY DRIVE
RUSKIN FL
33573
US

V. Phone/Fax

Practice location:
  • Phone: 813-228-7696
  • Fax: 813-228-0677
Mailing address:
  • Phone: 904-707-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9255162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: