MEDICARE: SANDRA FLODIN PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	62188966-8900	UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6218966-4405	UT

General Provider Information

NPI Number	:	1790661320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA FLODIN PMHNP-BC

Provider Business Mailing Address
First Line	:	9164 S MAISON DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-2434
Country	:	US
Telephone Number	:	801-597-2413
Fax Number	:

Provider Business Practice Location Address
First Line	:	9164 S MAISON DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-2434
Country	:	US
Telephone Number	:	801-597-2413
Fax Number	:

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

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	04/20/2026

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