Provider Demographics
NPI:1720302185
Name:SANDMAN, LAQUITA LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:LAQUITA
Middle Name:LYNNE
Last Name:SANDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0098
Mailing Address - Country:US
Mailing Address - Phone:931-879-5864
Mailing Address - Fax:931-879-1402
Practice Address - Street 1:100 DUNCAN STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-0098
Practice Address - Country:US
Practice Address - Phone:931-879-5864
Practice Address - Fax:931-879-1402
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily