Provider Demographics
NPI:1861484370
Name:SANDEL, TANA SIMS (PA C)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:SIMS
Last Name:SANDEL
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5500
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75712-5500
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1718 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3566
Practice Address - Country:US
Practice Address - Phone:903-983-2110
Practice Address - Fax:903-986-1186
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 04032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1431OtherBCBS BILLING NUMBER
TX8Y1431OtherBCBS BILLING NUMBER