Provider Demographics
NPI:1942931001
Name:SCOTT, SANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10279 GREEN MOSS DR S
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-0119
Mailing Address - Country:US
Mailing Address - Phone:901-634-9829
Mailing Address - Fax:
Practice Address - Street 1:8895 BRISTOL PARK DR APT 105
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4171
Practice Address - Country:US
Practice Address - Phone:901-634-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000032293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily