Healthcare Provider Details

I. General information

NPI: 1356881759
Provider Name (Legal Business Name): SANDY J HUTNICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 ORANGE AVE STE B
WINTER PARK FL
32789-4760
US

IV. Provider business mailing address

976 ORANGE AVE STE B
WINTER PARK FL
32789-4760
US

V. Phone/Fax

Practice location:
  • Phone: 407-314-0351
  • Fax:
Mailing address:
  • Phone: 407-314-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9181565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: