Provider Demographics
NPI:1417946278
Name:BROWN, SANDRA M (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:KLEVENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1000 E TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5438
Mailing Address - Country:US
Mailing Address - Phone:727-937-4203
Mailing Address - Fax:607-216-0587
Practice Address - Street 1:1000 E TARPON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5438
Practice Address - Country:US
Practice Address - Phone:727-937-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9383775363LF0000X
NYF331299-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02185317Medicaid
DD6015OtherMEDICARE PTAN
DD6015OtherMEDICARE PTAN
DD6015OtherMEDICARE PTAN