Provider Demographics
NPI:1346966637
Name:GARMON, SANDRA JO
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:GARMON
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 1:1460 BAYTREE DR NE STE D3
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3900
Mailing Address - Country:US
Mailing Address - Phone:321-499-4180
Mailing Address - Fax:321-327-8289
Practice Address - Street 1:1460 BAYTREE DR NE STE D3
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3900
Practice Address - Country:US
Practice Address - Phone:321-499-4180
Practice Address - Fax:321-327-8289
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9262342163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health