Provider Demographics
NPI:1790363372
Name:SANFORD, TERI JO (APRN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:JO
Last Name:SANFORD
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 1:6101 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-348-4000
Mailing Address - Fax:
Practice Address - Street 1:24231 WALDEN CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34134-5012
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:239-390-2486
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9559110163W00000X
FLAPRN11022547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty