Basic Information
| Provider Information | |||||||||
| NPI: | 1952694861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARGENT | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4529 E RED RANGE WAY | ||||||||
| Address2: | |||||||||
| City: | CAVE CREEK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853315038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805758786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8573 E PRINCESS DR | ||||||||
| Address2: | SUITE B-215 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852557819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805635757 | ||||||||
| FaxNumber: | 4805635851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP4071 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 758535 | 01 | AZ | GROUP MEDICAID | OTHER | 654729 | 05 | AZ | MEDICAID | Z102830 | 01 | AZ | GROUP PTAN | OTHER |