Provider Demographics
NPI:1487076873
Name:SANFORD, MICHELLE ANN (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:251-625-6897
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:251-625-6897
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-059045363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL192617Medicaid
AL102I506859OtherMEDICARE PTAN
ALP01576999OtherRAILROAD MEDICARE