Provider Demographics
NPI:1568056109
Name:BLANKS, SANDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLANKS
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 1:3208 COUNTY ROAD 667
Mailing Address - Street 2:
Mailing Address - City:HENAGAR
Mailing Address - State:AL
Mailing Address - Zip Code:35978-4862
Mailing Address - Country:US
Mailing Address - Phone:256-996-8944
Mailing Address - Fax:
Practice Address - Street 1:3208 COUNTY ROAD 667
Practice Address - Street 2:
Practice Address - City:HENAGAR
Practice Address - State:AL
Practice Address - Zip Code:35978-4862
Practice Address - Country:US
Practice Address - Phone:256-996-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty