Provider Demographics
NPI:1750049474
Name:SANANIKONE, RATSANY (APRN)
Entity Type:Individual
Prefix:
First Name:RATSANY
Middle Name:
Last Name:SANANIKONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1858
Mailing Address - Country:US
Mailing Address - Phone:561-810-9936
Mailing Address - Fax:
Practice Address - Street 1:CAMP ATTERBURY
Practice Address - Street 2:
Practice Address - City:EDINBURGH
Practice Address - State:IN
Practice Address - Zip Code:46124
Practice Address - Country:US
Practice Address - Phone:561-810-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily