Provider Demographics
NPI:1881688026
Name:HUNGERFORD, SALLY (CRNA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HUNGERFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:SACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13501 MOCCASIN GAP RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-7234
Mailing Address - Country:US
Mailing Address - Phone:352-214-6964
Mailing Address - Fax:
Practice Address - Street 1:13501 MOCCASIN GAP RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-7234
Practice Address - Country:US
Practice Address - Phone:352-214-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9188660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304936100Medicaid
FLG3145AMedicare ID - Type Unspecified