Provider Demographics
NPI:1205559986
Name:LACLAIR, SABRINA ANNE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:ANNE
Last Name:LACLAIR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 S MCCLINTOCK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5879
Mailing Address - Country:US
Mailing Address - Phone:352-212-8334
Mailing Address - Fax:
Practice Address - Street 1:758 N LYLE AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2628
Practice Address - Country:US
Practice Address - Phone:352-212-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9264278163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty