=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558653907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE SANDER ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2011
-----------------------------------------------------
Last Update Date | 02/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 E ADAMS ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32202-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-394-8056
-----------------------------------------------------
Fax | 904-359-0926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 E ADAMS ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32202-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-394-8056
-----------------------------------------------------
Fax | 904-359-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP1071492
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------