Healthcare Provider Details

I. General information

NPI: 1366036188
Provider Name (Legal Business Name): SANDRA YAZMIN PORTALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 W SPRING CREEK PKWY STE 200
PLANO TX
75024
US

IV. Provider business mailing address

5401 RAINCREST DR
MCKINNEY TX
75071-5576
US

V. Phone/Fax

Practice location:
  • Phone: 972-599-9600
  • Fax: 972-599-9696
Mailing address:
  • Phone: 214-476-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1030712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: