Healthcare Provider Details

I. General information

NPI: 1114369576
Provider Name (Legal Business Name): JOANNA GLORIA SANFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA GLORIA SANFORD PA-C

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5452
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2100
  • Fax:
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07253
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: