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General NPI Number Information
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NPI Number | 1063893378
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Entity Type | Individual
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Provider Name | ANDREW SADOUSKY MS, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 250 MIRON DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7852
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Country | US
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Telephone | 817-328-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 VILLA DI LAGO UNIT 3
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-6622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127302
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License Number State | TX
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