Provider Demographics
NPI:1447347885
Name:BOLDREGHINI, SANDRA J (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:BOLDREGHINI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 SUMMER OAKS CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2857
Mailing Address - Country:US
Mailing Address - Phone:901-373-7100
Mailing Address - Fax:901-842-0020
Practice Address - Street 1:6570 SUMMER OAKS CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2857
Practice Address - Country:US
Practice Address - Phone:901-373-7100
Practice Address - Fax:901-842-0020
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3640184Medicare PIN
TNQ41636Medicare UPIN