Provider Demographics
NPI:1982655940
Name:SANFORD, JORIE C (FNP)
Entity Type:Individual
Prefix:
First Name:JORIE
Middle Name:C
Last Name:SANFORD
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 1:484 COLLINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-3388
Mailing Address - Country:US
Mailing Address - Phone:318-649-5300
Mailing Address - Fax:318-649-3773
Practice Address - Street 1:484 COLLINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-3388
Practice Address - Country:US
Practice Address - Phone:318-649-5300
Practice Address - Fax:318-649-3773
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1140686Medicaid
LA4C494CD56Medicare ID - Type Unspecified
LA1140686Medicaid