Provider Demographics
NPI:1871863597
Name:FOSTER, SANDRIA JOAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRIA
Middle Name:JOAN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SANDRIA
Other - Middle Name:JOAN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1746 E SILVER STAR RD
Mailing Address - Street 2:SUITE 243
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:407-802-6766
Mailing Address - Fax:407-362-1761
Practice Address - Street 1:3343 ATMORE TER
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4442
Practice Address - Country:US
Practice Address - Phone:407-205-5510
Practice Address - Fax:407-703-4451
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001462363LG0600X
FL1136932163W00000X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692190696 96Medicaid
FL692190696 98Medicaid