Healthcare Provider Details

I. General information

NPI: 1598130700
Provider Name (Legal Business Name): NITA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S SEMORAN BLVD
WINTER PARK FL
32792-5533
US

IV. Provider business mailing address

5800 SW 61ST PL
OCALA FL
34474-5691
US

V. Phone/Fax

Practice location:
  • Phone: 321-397-3000
  • Fax:
Mailing address:
  • Phone: 352-615-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number215S00000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: