Provider Demographics
NPI:1811357775
Name:GEORGE, SANDRA K (ARNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 LAKELAND HILLS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3061
Mailing Address - Country:US
Mailing Address - Phone:636-688-6051
Mailing Address - Fax:208-977-3177
Practice Address - Street 1:1705 LAKELAND HILLS BLVD STE1
Practice Address - Street 2:
Practice Address - City:LAKELAMD
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-425-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA1014034363LA2200X
FL2681472363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care