Provider Demographics
NPI:1356818876
Name:ELLIOTT, SANDIE KATRINA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDIE
Middle Name:KATRINA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N. WITCHDUCK RD.
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-952-0180
Mailing Address - Fax:757-431-7336
Practice Address - Street 1:104 N. WITCHDUCK RD.
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-952-0180
Practice Address - Fax:757-431-7336
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily