Provider Demographics
NPI:1164465522
Name:SANDIFER, NICOLE L (APN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3976
Mailing Address - Country:US
Mailing Address - Phone:423-714-0714
Mailing Address - Fax:423-587-3799
Practice Address - Street 1:609 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3976
Practice Address - Country:US
Practice Address - Phone:423-714-0714
Practice Address - Fax:423-587-3799
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 12020363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3643310Medicaid
TN3643310Medicaid