Provider Demographics
NPI:1922329911
Name:CRAIG, SANDRA SCOTT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SCOTT
Last Name:CRAIG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 WINDLAKE DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4812
Mailing Address - Country:US
Mailing Address - Phone:850-897-3215
Mailing Address - Fax:
Practice Address - Street 1:4401 WINDLAKE DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4812
Practice Address - Country:US
Practice Address - Phone:850-897-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2808332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP44751Medicare UPIN