Provider Demographics
NPI:1639365828
Name:JONES, SANDRA GILLINS (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GILLINS
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 WALKER SOLOMON WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1131
Mailing Address - Country:US
Mailing Address - Phone:803-296-3244
Mailing Address - Fax:803-296-3245
Practice Address - Street 1:2133 WALKER SOLOMON WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1131
Practice Address - Country:US
Practice Address - Phone:803-296-3244
Practice Address - Fax:803-296-3245
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP17749Medicare UPIN