Provider Demographics
NPI:1609536077
Name:SANDLIN, VANESSA S (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:S
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:NP
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 594
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-0594
Mailing Address - Country:US
Mailing Address - Phone:719-649-8793
Mailing Address - Fax:
Practice Address - Street 1:18100 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9404
Practice Address - Country:US
Practice Address - Phone:719-839-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily