Provider Demographics
NPI:1396509360
Name:SANDERS, ALBERTINA ELISA
Entity type:Individual
Prefix:
First Name:ALBERTINA
Middle Name:ELISA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:A;BERTINA
Other - Middle Name:ELISA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:322 W OLD CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-9204
Mailing Address - Country:US
Mailing Address - Phone:843-687-1054
Mailing Address - Fax:
Practice Address - Street 1:322 W OLD CAMDEN RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-9204
Practice Address - Country:US
Practice Address - Phone:843-687-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC231414363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily