Provider Demographics
NPI:1699084392
Name:CARPENTER, SANDRA PATRICIA (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:PATRICIA
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:PATRICIA
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4200 N ARMENIA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6438
Mailing Address - Country:US
Mailing Address - Phone:813-922-3703
Mailing Address - Fax:813-872-8978
Practice Address - Street 1:4915 EHRLICH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2038
Practice Address - Country:US
Practice Address - Phone:813-960-2400
Practice Address - Fax:813-960-2410
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3287112363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1372292OtherCOVENTRY
FL9393932OtherAETNA
38909OtherBLUE CROSS
FL363022OtherAVMED
FLDQ281ZMedicare PIN