Provider Demographics
NPI:1033618541
Name:JACOMINO, SANDRA T (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:JACOMINO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-5122
Mailing Address - Country:US
Mailing Address - Phone:786-473-9234
Mailing Address - Fax:
Practice Address - Street 1:999 BRICKELL AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3012
Practice Address - Country:US
Practice Address - Phone:305-448-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9339764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine