Provider Demographics
NPI:1831714906
Name:DEXTER, SADYE GRACE (APRN)
Entity type:Individual
Prefix:MRS
First Name:SADYE
Middle Name:GRACE
Last Name:DEXTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 OAK BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7351
Mailing Address - Country:US
Mailing Address - Phone:386-366-4724
Mailing Address - Fax:
Practice Address - Street 1:35 OAK BROOK DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7351
Practice Address - Country:US
Practice Address - Phone:386-366-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1107566363LF0000X
FLRN9318920163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine