Provider Demographics
NPI:1265783179
Name:DEJESUS, SANDRA F (FNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:F
Last Name:DEJESUS
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 1:3209 LOCHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-2923
Mailing Address - Country:US
Mailing Address - Phone:214-793-2288
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C833
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2591
Practice Address - Country:US
Practice Address - Phone:972-566-4591
Practice Address - Fax:972-566-6679
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764715363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX764715OtherRN LICENSE
TXAP122354OtherLICENSE