Provider Demographics
NPI:1487739355
Name:LEVINE, SANDRA ADELINA (SANDRA LEVINE)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ADELINA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:SANDRA LEVINE
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN,PNP
Mailing Address - Street 1:5375 E ERICKSON DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2838
Mailing Address - Country:US
Mailing Address - Phone:520-319-0727
Mailing Address - Fax:
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-319-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051801363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ148773955Medicare PIN