Provider Demographics
NPI:1326511569
Name:SANDS, JONI ANNETTE
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:ANNETTE
Last Name:SANDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 N MILITARY TRL STE 508
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6296
Mailing Address - Country:US
Mailing Address - Phone:561-630-8001
Mailing Address - Fax:561-630-8007
Practice Address - Street 1:8645 N MILITARY TRL STE 508
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6296
Practice Address - Country:US
Practice Address - Phone:561-630-8001
Practice Address - Fax:561-630-8007
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000696363LX0001X
SC22441363LX0001X
FLAPRN11000696367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology