Provider Demographics
NPI:1538446414
Name:SANDERS COMPREHENSIVE CLINIC
Entity type:Organization
Organization Name:SANDERS COMPREHENSIVE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:FFRENCH-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-635-9611
Mailing Address - Street 1:7750 PALM RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4215
Mailing Address - Country:US
Mailing Address - Phone:813-635-9611
Mailing Address - Fax:813-635-0211
Practice Address - Street 1:7750 PALM RIVER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4215
Practice Address - Country:US
Practice Address - Phone:813-635-9611
Practice Address - Fax:813-635-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2602032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302385100Medicaid