Healthcare Provider Details

I. General information

NPI: 1952880932
Provider Name (Legal Business Name): SARAH MARTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT MARKS PL STE 160
LA GRANGE TX
78945-1253
US

IV. Provider business mailing address

2 SAINT MARKS PL STE 160
LA GRANGE TX
78945-1253
US

V. Phone/Fax

Practice location:
  • Phone: 979-242-5677
  • Fax: 979-242-5680
Mailing address:
  • Phone: 979-242-5677
  • Fax: 979-242-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: