Provider Demographics
NPI:1063445492
Name:HORWITZ, SANDRA SUE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SUE
Last Name:HORWITZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 BANDERA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3336
Mailing Address - Country:US
Mailing Address - Phone:214-887-6955
Mailing Address - Fax:214-887-6983
Practice Address - Street 1:6120 MOCKINGBIRD LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2601
Practice Address - Country:US
Practice Address - Phone:214-887-6955
Practice Address - Fax:214-887-6983
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111886363LF0000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157439401Medicaid
P67977Medicare UPIN
TX84P313Medicare PIN
TX157439401Medicaid