Healthcare Provider Details

I. General information

NPI: 1063781045
Provider Name (Legal Business Name): SANDRA O'PRY NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA BAUER

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MATLOCK RD
ARLINGTON TX
76015-2908
US

IV. Provider business mailing address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number627945
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number627945
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: