Provider Demographics
NPI:1275871246
Name:SANDERS, JAMIE BETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BETH
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:BETH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4870 BARRANCA PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4709
Mailing Address - Country:US
Mailing Address - Phone:949-791-3106
Mailing Address - Fax:949-791-3169
Practice Address - Street 1:4870 BARRANCA PKWY
Practice Address - Street 2:STE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4709
Practice Address - Country:US
Practice Address - Phone:949-791-3106
Practice Address - Fax:949-791-3169
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily