Provider Demographics
NPI:1013524685
Name:SANDERS, TREVENA NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:TREVENA
Middle Name:NICOLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 IVY BELLFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3098
Mailing Address - Country:US
Mailing Address - Phone:904-234-0339
Mailing Address - Fax:
Practice Address - Street 1:751 OAK ST STE 410
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3306
Practice Address - Country:US
Practice Address - Phone:904-634-7919
Practice Address - Fax:904-619-7956
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily