Provider Demographics
NPI:1790033892
Name:STREETMAN, SANDRA JEAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:STREETMAN
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 1:4295 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2120
Mailing Address - Country:US
Mailing Address - Phone:850-482-0017
Mailing Address - Fax:850-482-0018
Practice Address - Street 1:4295 3RD AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2120
Practice Address - Country:US
Practice Address - Phone:850-482-0017
Practice Address - Fax:850-482-0018
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2695302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner