Provider Demographics
NPI:1033559380
Name:SANDE, DOUGLAS (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SANDE
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2706
Mailing Address - Country:US
Mailing Address - Phone:305-751-8626
Mailing Address - Fax:
Practice Address - Street 1:6161 BLUE LAGOON DR
Practice Address - Street 2:170
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2057
Practice Address - Country:US
Practice Address - Phone:786-388-1400
Practice Address - Fax:786-388-1401
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213009363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care