Healthcare Provider Details

I. General information

NPI: 1790661320
Provider Name (Legal Business Name): SANDRA FLODIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E VINE ST STE 170
MURRAY UT
84121-2197
US

IV. Provider business mailing address

9164 S MAISON DR
SANDY UT
84093-2434
US

V. Phone/Fax

Practice location:
  • Phone: 801-639-9833
  • Fax: 801-639-9833
Mailing address:
  • Phone: 801-597-2413
  • Fax: 801-639-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number62188966-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6218966-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: