Provider Demographics
NPI:1053115394
Name:SANDERS, TAKIETAHA T (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TAKIETAHA
Middle Name:T
Last Name:SANDERS
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 E EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3833
Mailing Address - Country:US
Mailing Address - Phone:602-909-3767
Mailing Address - Fax:
Practice Address - Street 1:1247 E EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3833
Practice Address - Country:US
Practice Address - Phone:602-909-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily