Provider Demographics
NPI:1982957171
Name:RODRIGUEZ, SANDRA C (NP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:C
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:12487 TIERRA ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4524
Mailing Address - Country:US
Mailing Address - Phone:915-929-9409
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:915-208-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649668363LF0000X
TXAP122574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily