Provider Demographics
NPI:1942392816
Name:RIETH, SANDRA M (MSN ANP-BC CNRN CCRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:RIETH
Suffix:
Gender:F
Credentials:MSN ANP-BC CNRN CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9337
Mailing Address - Country:US
Mailing Address - Phone:941-893-2733
Mailing Address - Fax:
Practice Address - Street 1:2564 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9337
Practice Address - Country:US
Practice Address - Phone:941-893-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007269363L00000X
MO137630363LA2200X
FLARNP9432148363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner