Provider Demographics
NPI:1265917124
Name:JAYUSSI, SANDRA (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JAYUSSI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:11081 SW 57TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1101
Practice Address - Country:US
Practice Address - Phone:305-351-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38189363LA2100X
FLAPRN9391238363LA2100X
MO2025002427363LA2100X
AL3-002192363LA2100X
PASP032632363LA2100X
AZ319406363LA2200X
NC5021511363LA2200X
TX1189532363LA2200X
MS907193363LA2200X
OHAPRN.CNP.0038127363LA2200X
AR232385363LA2200X
IN71016666A363LA2200X
FL9391238363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9391238OtherFL NP LICENSE
FLRN9391238OtherFL RN LICENSE