Provider Demographics
NPI:1558502237
Name:ALMERICO, SANDRA R (APRN - ANP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:ALMERICO
Suffix:
Gender:F
Credentials:APRN - ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 CRESTWYN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8501
Mailing Address - Country:US
Mailing Address - Phone:901-261-4848
Mailing Address - Fax:901-261-4858
Practice Address - Street 1:28119 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3281
Practice Address - Country:US
Practice Address - Phone:877-260-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05758363LA2200X
LARN113088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1481441Medicaid
MS00834752Medicaid
LA1481441Medicaid