Provider Demographics
NPI:1073784054
Name:GRANT, SANDRA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 PARK NORTH CT
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2553
Mailing Address - Country:US
Mailing Address - Phone:407-928-1404
Mailing Address - Fax:
Practice Address - Street 1:318 PARK NORTH CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2553
Practice Address - Country:US
Practice Address - Phone:407-928-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2861772207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G1891AOtherMEDICARE ID CERTIFICATE