Provider Demographics
NPI:1366036188
Name:PORTALES, SANDRA YAZMIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:YAZMIN
Last Name:PORTALES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 RAINCREST DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5576
Mailing Address - Country:US
Mailing Address - Phone:214-476-5320
Mailing Address - Fax:
Practice Address - Street 1:5655 W SPRING CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-599-9600
Practice Address - Fax:972-599-9696
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily