Provider Demographics
NPI:1508694407
Name:ZIEGLER, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LORENA
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12623 KERNAN FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9501
Mailing Address - Country:US
Mailing Address - Phone:904-252-0352
Mailing Address - Fax:
Practice Address - Street 1:12623 KERNAN FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9501
Practice Address - Country:US
Practice Address - Phone:904-252-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231452163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health