Provider Demographics
NPI:1578680799
Name:SANFORD, PAULINE R (RN)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:R
Last Name:SANFORD
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 1:1022 FLORIDA AVE S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2145
Mailing Address - Country:US
Mailing Address - Phone:321-637-7700
Mailing Address - Fax:321-637-7707
Practice Address - Street 1:1022 FLORIDA AVE S
Practice Address - Street 2:SUITE 6
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2145
Practice Address - Country:US
Practice Address - Phone:321-637-7700
Practice Address - Fax:321-637-7707
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1642392163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics