Provider Demographics
NPI:1982616561
Name:ERNST, SANDRA D (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:ERNST
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 1:755 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-3802
Mailing Address - Country:US
Mailing Address - Phone:409-396-1222
Mailing Address - Fax:
Practice Address - Street 1:755 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3802
Practice Address - Country:US
Practice Address - Phone:409-386-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX242818OtherNURSE PRACTITIONERS