Provider Demographics
NPI:1538103080
Name:ROBERTS, SANDRA J (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:ROBERTS
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 1:1188 SKYLAND DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8002
Mailing Address - Country:US
Mailing Address - Phone:828-339-2273
Mailing Address - Fax:828-339-2274
Practice Address - Street 1:1188 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8002
Practice Address - Country:US
Practice Address - Phone:828-339-2273
Practice Address - Fax:828-339-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2547972363LW0102X
NC5017747363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302516100Medicaid
FL302516100Medicaid