Provider Demographics
NPI:1942635982
Name:SANDERS-KING, JACQUELYN KIERON (LPN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:KIERON
Last Name:SANDERS-KING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-2613
Mailing Address - Country:US
Mailing Address - Phone:407-936-5297
Mailing Address - Fax:
Practice Address - Street 1:631 DAVID ST
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2613
Practice Address - Country:US
Practice Address - Phone:407-936-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1292761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse