Healthcare Provider Details

I. General information

NPI: 1164465522
Provider Name (Legal Business Name): NICOLE L SANDIFER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WILSON BLVD FL 6
ARLINGTON VA
22209-2281
US

IV. Provider business mailing address

1101 WILSON BLVD FL 6
ARLINGTON VA
22209-2281
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN 12020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: