Provider Demographics
NPI:1821041310
Name:MCCOLLOUGH, SANDRA P (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:P
Last Name:MCCOLLOUGH
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 1:250 N ALAFAYA TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4315
Mailing Address - Country:US
Mailing Address - Phone:407-282-4400
Mailing Address - Fax:407-282-4191
Practice Address - Street 1:250 N ALAFAYA TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4315
Practice Address - Country:US
Practice Address - Phone:407-282-4400
Practice Address - Fax:407-282-4191
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN964052363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
080168407OtherRAILROAD MEDICARE
FL303692800Medicaid
FLY9985OtherBCBS
S71457Medicare UPIN