Healthcare Provider Details

I. General information

NPI: 1871426676
Provider Name (Legal Business Name): DANIELLE LYNETTE SANDERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 UNIVERSITY AVE
COLUMBUS GA
31907-5645
US

IV. Provider business mailing address

218 LASSO DR
WARNER ROBINS GA
31088-6660
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: