Provider Demographics
NPI:1659776078
Name:TERRAZZANO, SANDRA J (ARNP, LMT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:J
Last Name:TERRAZZANO
Suffix:
Gender:F
Credentials:ARNP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3608
Mailing Address - Country:US
Mailing Address - Phone:904-887-8420
Mailing Address - Fax:904-242-8420
Practice Address - Street 1:1208 10TH ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3608
Practice Address - Country:US
Practice Address - Phone:904-887-8420
Practice Address - Fax:904-242-8420
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16677225700000X
FL905032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist