Provider Demographics
NPI:1053824334
Name:EARLY, SANDRA LOREN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOREN
Last Name:EARLY
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LOREN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6117 TROUBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-5240
Mailing Address - Country:US
Mailing Address - Phone:727-845-5707
Mailing Address - Fax:
Practice Address - Street 1:6117 TROUBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5240
Practice Address - Country:US
Practice Address - Phone:800-561-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23453363L00000X
FL11010433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner