Provider Demographics
NPI:1811385206
Name:THARPE, SANDRA JEAN (APN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:THARPE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:OWENS
Other - Last Name:THARPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:710 CARL PERKINS PKWY
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1678
Mailing Address - Country:US
Mailing Address - Phone:731-253-6690
Mailing Address - Fax:731-253-6692
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:TN
Practice Address - Zip Code:38080-1317
Practice Address - Country:US
Practice Address - Phone:731-264-5518
Practice Address - Fax:731-264-9859
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily