Provider Demographics
NPI:1518495720
Name:TOUSSAINT-PHANOR, SANDRA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:TOUSSAINT-PHANOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 NW 11TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5913
Mailing Address - Country:US
Mailing Address - Phone:954-483-0281
Mailing Address - Fax:
Practice Address - Street 1:410 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5584
Practice Address - Country:US
Practice Address - Phone:954-454-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9420051163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management