Basic Information
Provider Information
NPI: 1033559380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANDE
FirstName: DOUGLAS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5200 NE 2ND AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331372706
CountryCode: US
TelephoneNumber: 3057518626
FaxNumber:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XARNP9213009FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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