Provider Demographics
NPI:1245453562
Name:JONES, SANDRA S (RN, APN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4410
Mailing Address - Country:US
Mailing Address - Phone:901-380-0991
Mailing Address - Fax:
Practice Address - Street 1:650 NEW YORK ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5536
Practice Address - Country:US
Practice Address - Phone:901-728-5858
Practice Address - Fax:901-531-6312
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN47346163W00000X
TN00005463363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN47346OtherRN LICENSE
TNAPN005463OtherAPN LICENSE