Provider Demographics
NPI:1477058774
Name:HECTOR, SANDRA (PHN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HECTOR
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 POST HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3656
Mailing Address - Country:US
Mailing Address - Phone:813-500-1065
Mailing Address - Fax:
Practice Address - Street 1:10150 HIGHLAND MANOR DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9713
Practice Address - Country:US
Practice Address - Phone:813-314-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL999OtherPUBLIC HEALTH NUTRITIONIST EDUCATOR
FL999OtherNUTRITION EDUCATOR