Provider Demographics
NPI:1730928540
Name:SANFORD, AMANDA MOORMAN (CRNP FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MOORMAN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CRNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EMINENCE WAY
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-2337
Mailing Address - Country:US
Mailing Address - Phone:205-884-9000
Mailing Address - Fax:
Practice Address - Street 1:41 EMINENCE WAY
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-2337
Practice Address - Country:US
Practice Address - Phone:205-884-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-119340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily