Provider Demographics
NPI:1902439607
Name:GREGORISCH, SANDRA (APRN-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GREGORISCH
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PIEDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3381 SW 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1699
Mailing Address - Country:US
Mailing Address - Phone:305-898-3323
Mailing Address - Fax:
Practice Address - Street 1:1005 JOE DIMAGGIO DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5402
Practice Address - Country:US
Practice Address - Phone:954-265-5324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006123363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal