Provider Demographics
NPI:1063793578
Name:SANDERS, RAPHAEL (LPN)
Entity type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 4TH ST N
Mailing Address - Street 2:#4502
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2914
Mailing Address - Country:US
Mailing Address - Phone:813-793-1579
Mailing Address - Fax:
Practice Address - Street 1:11150 4TH ST N
Practice Address - Street 2:#4502
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2914
Practice Address - Country:US
Practice Address - Phone:813-793-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5182360164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse