Provider Demographics
NPI:1801268248
Name:NEVAREZ, SANDRA JOY TECSON (NP)
Entity type:Individual
Prefix:
First Name:SANDRA JOY
Middle Name:TECSON
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANDRA JOY
Other - Middle Name:TECSON
Other - Last Name:DELA VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1343 MONTGOMERY BELL RD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-0016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 720
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6378
Practice Address - Country:US
Practice Address - Phone:813-405-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339347363LF0000X
VA0024177155363LF0000X
FLAPRN11006108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily