MEDICARE: SANDRA OLIVAS FNP-C

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	363LF0000X	Family Nurse Practitioner	1114991	TX

General Provider Information

NPI Number	:	1831971977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA OLIVAS FNP-C

Provider Business Mailing Address
First Line	:	4003 SANTA ANA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1321
Country	:	US
Telephone Number	:	915-329-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	11450 GATEWAY BLVD N STE 1100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3460
Country	:	US
Telephone Number	:	915-205-3440
Fax Number	:

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

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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