Provider Demographics
NPI:1760577621
Name:SANDERS, DEBORAH ROSE (MSN CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ROSE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N JACKSON ST
Mailing Address - Street 2:BLDG A STE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-455-7767
Mailing Address - Fax:931-455-8636
Practice Address - Street 1:1805 N JACKSON ST
Practice Address - Street 2:BLDG A STE 100
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-455-7767
Practice Address - Fax:931-455-8636
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153265OtherBCBS
TN500013237OtherRR MCR
TN3341058Medicaid
R08725Medicare UPIN
TN3341050Medicare PIN