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NPI Code Detail

MEDICARE: MRS. SANDRA JEAN STREETMAN ARNP

MEDICARE: MRS. SANDRA JEAN STREETMAN 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
1363L00000XNurse PractitionerARNP2695302FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790033892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA JEAN STREETMAN ARNP
Provider Business Mailing Address
First Line : 4295 3RD AVE
Second Line :
City : MARIANNA
State : FL
Zip : 32446-2120
Country : US
Telephone Number : 850-482-0017
Fax Number : 850-482-0018
Provider Business Practice Location Address
First Line : 4295 3RD AVE
Second Line :
City : MARIANNA
State : FL
Zip : 32446-2120
Country : US
Telephone Number : 850-482-0017
Fax Number : 850-482-0018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2012
Last Update Date : 08/21/2012

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