MEDICARE: MRS. SANDRA TOUSSAINT-PHANOR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN9420051	FL

General Provider Information

NPI Number	:	1518495720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA TOUSSAINT-PHANOR RN

Provider Business Mailing Address
First Line	:	7411 NW 11TH CT
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33313-5913
Country	:	US
Telephone Number	:	954-483-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5584
Country	:	US
Telephone Number	:	954-454-5777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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