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General NPI Number Information
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NPI Number | 1437331733
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Entity Type | Individual
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Provider Name | NICOLE SUNDERLAND ANDERSON MD
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Gender | Female
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 1235 SAN MARCO BLVD SUITE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8554
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Country | US
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Telephone | 904-202-7020
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Fax | 904-202-7029
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Provider Business Mailing Address
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Address Line | PO BOX 19675
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City | JACKSONVILLE
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State | FL
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Zip | 32245-9675
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Country | US
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Telephone | 904-309-8680
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Fax | 904-345-5841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME 111558
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License Number State | FL
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