Provider Demographics
NPI:1265670053
Name:SANDERLIN, MIRIAM R (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:R
Last Name:SANDERLIN
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 1:5151 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3926
Mailing Address - Country:US
Mailing Address - Phone:407-296-5177
Mailing Address - Fax:407-521-4699
Practice Address - Street 1:5151 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3926
Practice Address - Country:US
Practice Address - Phone:407-296-5177
Practice Address - Fax:407-521-4699
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP623922363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3011925-00Medicaid
FLARNP623922OtherARNP LICENSE
FL1265670053OtherNPI