Provider Demographics
NPI:1598154809
Name:SANFORD, RUBY MONICA (ACNP)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:MONICA
Last Name:SANFORD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 PUNTA LORA
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7902
Mailing Address - Country:US
Mailing Address - Phone:850-612-2006
Mailing Address - Fax:
Practice Address - Street 1:2120 E JOHNSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6091
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:850-476-9352
Is Sole Proprietor?:No
Enumeration Date:2015-01-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3361572363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care