MEDICARE: SANDRA IRIS PATTI APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	1141868	TX

General Provider Information

NPI Number	:	1033972765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA IRIS PATTI APN

Provider Business Mailing Address
First Line	:	2826 REDRIVER HL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-3555
Country	:	US
Telephone Number	:	210-901-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 FREDERICKSBURG RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-1969
Country	:	US
Telephone Number	:	210-317-5111
Fax Number	:	210-317-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	05/21/2026

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