Provider Demographics
NPI:1811181985
Name:KLOMAN, SANDRA PAQUINGAN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:PAQUINGAN
Last Name:KLOMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PAQUINGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 893
Mailing Address - Street 2:MEDICAL PROFESSIONAL AGENCY
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32572-0893
Mailing Address - Country:US
Mailing Address - Phone:850-623-2948
Mailing Address - Fax:850-626-2734
Practice Address - Street 1:9400 UNIVERSITY PARKWAY #10C
Practice Address - Street 2:MEDICAL PROFESSIONAL AGENCY
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-623-2948
Practice Address - Fax:850-626-2734
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3358402163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse