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General NPI Number Information
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NPI Number | 1689915167
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Entity Type | Individual
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Provider Name | JUSTINA SANDERS
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Gender | Female
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 111 SE OSCEOLA ST
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City | STUART
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State | FL
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Zip | 34994-2114
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Country | US
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Telephone | 866-724-6807
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Fax |
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Provider Business Mailing Address
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Address Line | 8136 SE WINDJAMMER WAY
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City | HOBE SOUND
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State | FL
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Zip | 33455-3903
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1104320
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9107807
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License Number State | FL
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