Provider Demographics
NPI:1124247903
Name:CONNELL, SANDRA (CST)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 SE BIBLE CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-1190
Mailing Address - Country:US
Mailing Address - Phone:352-214-8227
Mailing Address - Fax:
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 401
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-0030
Practice Address - Fax:352-332-0039
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90802OtherCST NUMBER
FLRN9452439OtherMEDICAL LICENSE
FL8VRAPOtherFLORIDA BLUE