Provider Demographics
NPI:1306285259
Name:GREY, SACKELIA (RN)
Entity type:Individual
Prefix:
First Name:SACKELIA
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 TRAFALGAR CT STE 200E
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:851 TRAFALGAR CT STE 200E
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7420
Practice Address - Country:US
Practice Address - Phone:888-339-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2021-07-21
Deactivation Date:2018-06-06
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
VA0001276563163W00000X, 390200000X
NY659703-1163W00000X
FLAPRN11013961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program