Provider Demographics
NPI:1699435164
Name:RUSNAK, SANDRA (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 SCARAMUCHE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7939
Mailing Address - Country:US
Mailing Address - Phone:689-777-0239
Mailing Address - Fax:
Practice Address - Street 1:1412 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4051
Practice Address - Country:US
Practice Address - Phone:407-483-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9454456163W00000X
FLAPRN11017138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse