Provider Demographics
NPI:1407510654
Name:SANDOVAL, DANIEL (RN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 BUCHANNAN DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3674
Mailing Address - Country:US
Mailing Address - Phone:787-203-4789
Mailing Address - Fax:
Practice Address - Street 1:612 BUCHANNAN DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3674
Practice Address - Country:US
Practice Address - Phone:787-203-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9474383163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse