Provider Demographics
NPI:1972745206
Name:RISOLDI, SANDRA L (DNP, RN, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:RISOLDI
Suffix:
Gender:F
Credentials:DNP, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-0190
Mailing Address - Country:US
Mailing Address - Phone:727-249-4898
Mailing Address - Fax:727-295-1648
Practice Address - Street 1:110 ATHENS STREET
Practice Address - Street 2:STE O
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3304
Practice Address - Country:US
Practice Address - Phone:727-249-4898
Practice Address - Fax:727-295-1648
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403913363LP0808X, 363LP0808X
FLAPRN11017154363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1972745206Medicaid