Individual
SANDRA CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
6440 W NEWBERRY RD, SUITE 401, GAINESVILLE, FL 32605-4381
(352) 332-0030
(352) 332-0039
Mailing address
813 SE BIBLE CAMP ST, HIGH SPRINGS, FL 32643-1190
(352) 214-8227
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9452439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8VRAP
FLORIDA BLUE
FL
01
—
90802
CST NUMBER
FL
01
—
RN9452439
MEDICAL LICENSE
FL
Enumeration date
04/24/2007
Last updated
07/18/2017
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