Provider Demographics
NPI:1457352460
Name:COFFEY, SANDRA (FNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:2974 BAKER HWY
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-0250
Mailing Address - Country:US
Mailing Address - Phone:423-663-4882
Mailing Address - Fax:423-663-8125
Practice Address - Street 1:715 RUGBY HWY
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:TN
Practice Address - Zip Code:37852-3721
Practice Address - Country:US
Practice Address - Phone:423-627-2782
Practice Address - Fax:423-627-2188
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN131089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902938Medicaid
TN3902938Medicaid
TNP25786Medicare UPIN