Provider Demographics
NPI:1770749202
Name:NICHOLS, SANDRA W (APRN, FNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:W
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1700 PLEASURE HOUSE RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4062
Mailing Address - Country:US
Mailing Address - Phone:757-251-0879
Mailing Address - Fax:984-220-9437
Practice Address - Street 1:1700 PLEASURE HOUSE RD STE 102A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4062
Practice Address - Country:US
Practice Address - Phone:757-251-0879
Practice Address - Fax:984-220-9437
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004963363L00000X
AZAP10570363L00000X, 363LP0808X
TN21255363L00000X
VA0024171054363LF0000X, 363LP0808X
FLARNP9241995363LF0000X
GA184239363LF0000X, 363LP0808X
NC5012159363LP0808X, 363LP0808X
FL9241995363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily