Provider Demographics
NPI:1396401113
Name:SANDERSON, SANDRA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 SAYBROOK XING
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5343
Mailing Address - Country:US
Mailing Address - Phone:615-495-7981
Mailing Address - Fax:
Practice Address - Street 1:1360 SAYBROOK XING
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5343
Practice Address - Country:US
Practice Address - Phone:615-495-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily