Provider Demographics
NPI:1174624548
Name:SANDROCK, LYNNETTE C (CNM ARNP)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:C
Last Name:SANDROCK
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 COLUMBIA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3589
Mailing Address - Country:US
Mailing Address - Phone:813-258-3309
Mailing Address - Fax:813-251-4454
Practice Address - Street 1:4 COLUMBIA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3589
Practice Address - Country:US
Practice Address - Phone:813-258-3309
Practice Address - Fax:813-251-4454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2706212367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61371Medicare UPIN