Provider Demographics
NPI:1336419373
Name:SANFORD, LINDA OLSON (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:OLSON
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 1:32100 SEDCO HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8203
Mailing Address - Country:US
Mailing Address - Phone:951-252-7816
Mailing Address - Fax:951-471-4034
Practice Address - Street 1:1309 S MISSION RD
Practice Address - Street 2:SUITE B
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4167
Practice Address - Country:US
Practice Address - Phone:760-451-3500
Practice Address - Fax:760-451-3504
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily