Provider Demographics
NPI:1730116765
Name:COLVETT, SANDRA JAFFE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JAFFE
Last Name:COLVETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 SE PORT ST. LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5108
Mailing Address - Country:US
Mailing Address - Phone:772-579-5615
Mailing Address - Fax:772-873-1846
Practice Address - Street 1:560 SE PORT ST. LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5108
Practice Address - Country:US
Practice Address - Phone:772-579-5615
Practice Address - Fax:772-873-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3279632163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY053RZMedicare ID - Type Unspecified
NYS04281Medicare UPIN