Provider Demographics
NPI:1336515162
Name:SANFORD, MARK (FNP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SANFORD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 QUARTZ MILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2326
Mailing Address - Country:US
Mailing Address - Phone:302-593-9773
Mailing Address - Fax:
Practice Address - Street 1:14 QUARTZ MILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-2326
Practice Address - Country:US
Practice Address - Phone:302-593-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily