Basic Information
| Provider Information | |||||||||
| NPI: | 1104166057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDI | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | ZAINABU | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 WEKIVA COMMONS CIR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327123645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074649516 | ||||||||
| FaxNumber: | 4074649519 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 WEKIVA COMMONS CIR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327123645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074649516 | ||||||||
| FaxNumber: | 4074649519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2013 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | ARNP9356773 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | APRN9356773 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP9356773 | 01 | FL | MEDICAL LICENSE | OTHER | 008660400 | 05 | FL | MEDICAID |