Provider Demographics
NPI:1134592561
Name:SANFORD, AMBER RENAE (ARNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RENAE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-4708
Mailing Address - Country:US
Mailing Address - Phone:352-838-3826
Mailing Address - Fax:
Practice Address - Street 1:2255 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-4708
Practice Address - Country:US
Practice Address - Phone:352-838-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9294584363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health