Provider Demographics
NPI:1780185686
Name:BOND, SANDRA RENEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RENEE
Last Name:BOND
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 1:2707 JACKSBORO PIKE STE 1A
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2752
Mailing Address - Country:US
Mailing Address - Phone:423-907-8186
Mailing Address - Fax:423-907-8187
Practice Address - Street 1:2707 JACKSBORO PIKE STE 1A
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2752
Practice Address - Country:US
Practice Address - Phone:423-907-8186
Practice Address - Fax:423-907-8187
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036604Medicaid