Provider Demographics
NPI:1063407880
Name:SANFORD, ROBERT C (ARNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:SANFORD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:5220 BELFORT RD
Practice Address - Street 2:SUITE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6017
Practice Address - Country:US
Practice Address - Phone:904-446-3451
Practice Address - Fax:904-446-3013
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202171363L00000X
FLARNP 9202171163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306547200Medicaid
FLP00809977OtherRR MCR ATTACHED TO GRP# CJ8845
FLY135UOtherBCBS
FLY135UOtherBCBS
FLUC058YMedicare PIN
FLU3058WMedicare PIN
Q23569Medicare UPIN