Provider Demographics
NPI:1912203142
Name:SIMS, SANDRA J (DNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:SIMS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4901 CHESAPEAKE DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216
Mailing Address - Country:US
Mailing Address - Phone:980-321-3337
Mailing Address - Fax:
Practice Address - Street 1:4901 CHESAPEAKE DR.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216
Practice Address - Country:US
Practice Address - Phone:980-321-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF4438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily