Provider Demographics
NPI:1972393197
Name:PETMECKY, SANDRA DEE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:PETMECKY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 W 3RD ST APT 436
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3194
Mailing Address - Country:US
Mailing Address - Phone:512-653-5598
Mailing Address - Fax:
Practice Address - Street 1:19500 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1108
Practice Address - Country:US
Practice Address - Phone:512-653-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily