Provider Demographics
NPI:1063448702
Name:JOACHIM, SANDRA VERRET (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:VERRET
Last Name:JOACHIM
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VERRET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:418 MARLBERRY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3694
Mailing Address - Country:US
Mailing Address - Phone:407-319-3749
Mailing Address - Fax:
Practice Address - Street 1:1403 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1000
Practice Address - Country:US
Practice Address - Phone:407-323-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant