Provider Demographics
NPI:1508319856
Name:MCNEAL, SANDRA NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:NICOLE
Last Name:MCNEAL
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:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0371
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:280 E WILLOW CREEK LN
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-5128
Practice Address - Country:US
Practice Address - Phone:229-868-0017
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN212138OtherADVANCE PRACTICE NP LICENSE