Healthcare Provider Details

I. General information

NPI: 1578520557
Provider Name (Legal Business Name): SANDRA B. PULASKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA JEAN BRUBAKER APN

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE SUITE 115
MARIETTA GA
30067-8665
US

IV. Provider business mailing address

494 MAXWELL RD
ROSWELL GA
30075-3726
US

V. Phone/Fax

Practice location:
  • Phone: 770-980-1818
  • Fax: 770-980-1873
Mailing address:
  • Phone: 770-883-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR137019
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2045242
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR137019
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2045242
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR137019
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2045242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: