Provider Demographics
NPI:1245685312
Name:RATNER, SANDY LON (RN)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LON
Last Name:RATNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PRINCESS KATHLEEN LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7132
Mailing Address - Country:US
Mailing Address - Phone:386-931-0409
Mailing Address - Fax:
Practice Address - Street 1:39 PRINCESS KATHLEEN LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7132
Practice Address - Country:US
Practice Address - Phone:386-931-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2843582363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily