Healthcare Provider Details

I. General information

NPI: 1144213349
Provider Name (Legal Business Name): SANDRA ELIZABETH TERRAZZINO APRN (FNP)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4457
  • Fax:
Mailing address:
  • Phone: 210-916-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number585440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: