Provider Demographics
NPI:1003219700
Name:COLEMAN, SANDRA MARIE (MSN, APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 VISTA RIDGE DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-8805
Mailing Address - Country:US
Mailing Address - Phone:469-337-1551
Mailing Address - Fax:
Practice Address - Street 1:3313 S BECKLEY AVE
Practice Address - Street 2:BUILDING E - CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4003
Practice Address - Country:US
Practice Address - Phone:214-932-5184
Practice Address - Fax:214-932-7397
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681079171M00000X
TX1035054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator