Provider Demographics
NPI:1659042455
Name:SANDUSKY, RENEE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10193 OAK CREST RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8251
Mailing Address - Country:US
Mailing Address - Phone:407-987-9752
Mailing Address - Fax:772-223-6354
Practice Address - Street 1:3727 N GOLDENROD RD STE 103
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028816363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care