Provider Demographics
NPI:1174588404
Name:PALMER, SANDRA H (ARNP-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:PALMER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4707
Mailing Address - Country:US
Mailing Address - Phone:850-763-5409
Mailing Address - Fax:850-763-7129
Practice Address - Street 1:204 E 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4707
Practice Address - Country:US
Practice Address - Phone:850-763-5409
Practice Address - Fax:850-763-7129
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 891762363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E6990ZMedicare ID - Type Unspecified
P51782Medicare UPIN