Provider Demographics
NPI:1215251442
Name:SANDRA E. EGINTON
Entity type:Organization
Organization Name:SANDRA E. EGINTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ESMERALDA
Authorized Official - Last Name:EGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-403-1127
Mailing Address - Street 1:2005 S.W. PROVICENCE PLACE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-0458
Mailing Address - Country:US
Mailing Address - Phone:951-403-1127
Mailing Address - Fax:
Practice Address - Street 1:2005 S.W. PROVICENCE PLACE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-0458
Practice Address - Country:US
Practice Address - Phone:951-403-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management