Provider Demographics
NPI:1548694359
Name:SMITH, SANDRA L (APN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9852 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-1804
Mailing Address - Country:US
Mailing Address - Phone:731-364-2210
Mailing Address - Fax:731-364-2986
Practice Address - Street 1:9852 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-1804
Practice Address - Country:US
Practice Address - Phone:731-364-2210
Practice Address - Fax:731-364-2986
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 0000006540363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care