Provider Demographics
NPI:1235486002
Name:SANDERS, JUDITH (FNP)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 N IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-2304
Mailing Address - Country:US
Mailing Address - Phone:512-478-4939
Mailing Address - Fax:512-708-1835
Practice Address - Street 1:2909 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2304
Practice Address - Country:US
Practice Address - Phone:512-478-4939
Practice Address - Fax:512-708-1835
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337217363LF0000X
TX730861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY00695941Medicaid