Provider Demographics
NPI:1285400507
Name:PRIDDLE, SANDRA LEE (NURSE AGENCY)
Entity type:Individual
Prefix:PROF
First Name:SANDRA
Middle Name:LEE
Last Name:PRIDDLE
Suffix:
Gender:F
Credentials:NURSE AGENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SW 10TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2551
Mailing Address - Country:US
Mailing Address - Phone:239-309-9192
Mailing Address - Fax:
Practice Address - Street 1:216 SW 10TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2551
Practice Address - Country:US
Practice Address - Phone:239-309-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5214938164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse