Provider Demographics
NPI:1952694861
Name:SARGENT, SANDY R (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:R
Last Name:SARGENT
Suffix:
Gender:F
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 1:4529 E RED RANGE WAY
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5038
Mailing Address - Country:US
Mailing Address - Phone:480-575-8786
Mailing Address - Fax:
Practice Address - Street 1:8573 E PRINCESS DR
Practice Address - Street 2:SUITE B-215
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:480-563-5757
Practice Address - Fax:480-563-5851
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ758535OtherGROUP MEDICAID
AZ654729Medicaid
AZZ102830OtherGROUP PTAN
AZ758535OtherGROUP MEDICAID