Provider Demographics
NPI:1316402449
Name:SEPAUL, SOPHIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SEPAUL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2113
Mailing Address - Country:US
Mailing Address - Phone:754-204-3096
Mailing Address - Fax:
Practice Address - Street 1:6621 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-2113
Practice Address - Country:US
Practice Address - Phone:754-204-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily