Provider Demographics
NPI:1871008607
Name:AMAZAN, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:AMAZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3430
Mailing Address - Country:US
Mailing Address - Phone:407-970-5558
Mailing Address - Fax:
Practice Address - Street 1:5 FAIRGREEN AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6112
Practice Address - Country:US
Practice Address - Phone:407-970-5558
Practice Address - Fax:407-970-5558
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12638310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility