Basic Information
| Provider Information | |||||||||
| NPI: | 1033559380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDE | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 NE 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331372706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057518626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6161 BLUE LAGOON DR | ||||||||
| Address2: | 170 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331262057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863881400 | ||||||||
| FaxNumber: | 7863881401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | ARNP9213009 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.