Provider Demographics
NPI:1275863698
Name:SANDQUIST, JEFFREY DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:SANDQUIST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:DAVID
Other - Last Name:LINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5200
Mailing Address - Fax:651-730-3556
Practice Address - Street 1:15700 37TH AVE N STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3675
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:763-557-4933
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13573363A00000X, 363A00000X
MN19402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer