Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9264502 | FL |
NPI | 1023540580 |
---|---|
Provider Name | Diane Sanjines |
First Address | St Augustine, FL 32086-5775 |
Second Address | St Augustine, FL 32086-5775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 16/04/2018 |