Individual provider Active NPI

Lucretia D Sanders

  • Family Nurse Practitioner
  • Tacoma, WA
National Provider Identifier
1518572353
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95101845 Issued in CA
Practice address
9040 Jackson Ave
Tacoma, WA 98431-2906
Phone
(253) 968-1110
NPI assigned
Sep 9, 2020
Last updated
Dec 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704405893 MI
Nurse Practitioner 363L00000X APRN11009023 FL
Nurse Practitioner 363L00000X 64287 NM
Nurse Practitioner 363L00000X 267202 AZ
Nurse Practitioner 363L00000X 000161 GA
Nurse Practitioner 363L00000X 1034893 TX
Family Nurse Practitioner 363LF0000X 10019393 OR
Family Nurse Practitioner 363LF0000X 864315 NV
Family Nurse Practitioner 363LF0000X 849714 NY
Family Nurse Practitioner 363LF0000X C-APN.0100513 CO
Family Nurse Practitioner 363LF0000X 24604A SC
Family Nurse Practitioner 363LF0000X 95101845 CA Primary

Addresses

Primary practice location

9040 Jackson Ave
Tacoma, WA 98431-2906

Mailing address

1317 Edgewater Dr # 3761
Orlando, FL 32804-6350
Phone (407) 500-3779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
000161GAMDAcupuncturist
267202AZMDNurse Practitioner
APRN11009023FLMDNurse Practitioner
4704405893MIMDNurse Practitioner
64287NMMDNurse Practitioner
1034893TXMDNurse Practitioner
95101845CAMDFamily Nurse Practitioner
C-APN.0100513COMDFamily Nurse Practitioner
864315NVMDFamily Nurse Practitioner
849714NYMDFamily Nurse Practitioner
10019393ORMDFamily Nurse Practitioner
24604ASCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lucretia.sanders.p1@direct.cmcentersinc.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1518572353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 EDGEWATER DR # 3761",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046350",
            "telephone_number": "407-500-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984312906",
            "telephone_number": "253-968-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "LUCRETIA",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704405893",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11009023",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "64287",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "267202",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "000161",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1034893",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10019393",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "864315",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "849714",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "C-APN.0100513",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "24604A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95101845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.