Provider Demographics
NPI:1639167224
Name:BAUMAN, SANDRA S (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SPEIGEL
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E OAKLAND PARK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4400
Mailing Address - Country:US
Mailing Address - Phone:954-561-6222
Mailing Address - Fax:954-990-7650
Practice Address - Street 1:1400 E OAKLAND PARK BLVD STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4400
Practice Address - Country:US
Practice Address - Phone:954-561-6222
Practice Address - Fax:954-990-7650
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 718562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034491500Medicaid
FLY3786YMedicare PIN
FLY3786YMedicare PIN