Provider Demographics
NPI:1760476881
Name:BAILIFF, SANDRA L (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BAILIFF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1726
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:931-783-6760
Practice Address - Street 1:128 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2493
Practice Address - Country:US
Practice Address - Phone:931-783-4600
Practice Address - Fax:931-783-4699
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid
TNPENDINGMedicaid
TN3908694Medicaid
TNP31957Medicare UPIN
TN3908694Medicaid
TN3908694Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
TN39086931Medicare PIN