MEDICARE: SANDRA CLARK-RAGL ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP587892	FL

General Provider Information

NPI Number	:	1689693913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA CLARK-RAGL ARNP

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-0417
Country	:	US
Telephone Number	:	772-223-5665
Fax Number	:	772-223-5646

Provider Business Practice Location Address
First Line	:	2392 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34996-3310
Country	:	US
Telephone Number	:	772-223-5628
Fax Number	:	772-223-4949

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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