Provider Demographics
NPI:1083940381
Name:JENNINGS INGLE, SANDRA M (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:JENNINGS INGLE
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:PO BOX 561600
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-1600
Mailing Address - Country:US
Mailing Address - Phone:321-868-5833
Mailing Address - Fax:321-868-5854
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:SUITE 601
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3577
Practice Address - Country:US
Practice Address - Phone:321-868-5833
Practice Address - Fax:321-868-5854
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2055442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292606700Medicaid
FLCP566OtherMEDICARE