Provider Demographics
NPI:1437160280
Name:FUJITA, SANDRA JOAQUINA (LCSW, ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOAQUINA
Last Name:FUJITA
Suffix:
Gender:F
Credentials:LCSW, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5308
Mailing Address - Country:US
Mailing Address - Phone:305-333-8482
Mailing Address - Fax:
Practice Address - Street 1:450 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5308
Practice Address - Country:US
Practice Address - Phone:305-333-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW22011041C0700X
FLARNP 9227719363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4003Medicare ID - Type Unspecified