Individual
NICOLE SUNDERLAND ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1235 SAN MARCO BLVD, SUITE 100, JACKSONVILLE, FL 32207-8554
(904) 202-7020
(904) 202-7029
Mailing address
PO BOX 19675, JACKSONVILLE, FL 32245-9675
(904) 309-8680
(904) 345-5841
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME 111558
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003120545A
—
GA
05
—
004305000
—
FL
01
—
14J0N
BCBS
FL
01
—
351861
AVMED
FL
Enumeration date
11/29/2007
Last updated
07/31/2012
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