Provider Demographics
NPI:1720608250
Name:SANFORD, BENARAH (APRN)
Entity type:Individual
Prefix:MS
First Name:BENARAH
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 KILLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2827
Mailing Address - Country:US
Mailing Address - Phone:386-366-0315
Mailing Address - Fax:
Practice Address - Street 1:1172 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1381
Practice Address - Country:US
Practice Address - Phone:386-206-8069
Practice Address - Fax:386-206-8069
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005838363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health