Provider Demographics
NPI:1750944401
Name:SANDOVAL, DAVID ANTHONY (FNP-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BUNCOMBE ST
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-1012
Mailing Address - Country:US
Mailing Address - Phone:803-221-5367
Mailing Address - Fax:
Practice Address - Street 1:403 BUNCOMBE ST
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-1012
Practice Address - Country:US
Practice Address - Phone:803-221-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC224084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily