Healthcare Provider Details

I. General information

NPI: 1538009030
Provider Name (Legal Business Name): SARAH I BACK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 DEEP WATER DR
SPRING BRANCH TX
78070-6092
US

IV. Provider business mailing address

805 DEEP WATER DR
SPRING BRANCH TX
78070-6092
US

V. Phone/Fax

Practice location:
  • Phone: 210-383-8446
  • Fax:
Mailing address:
  • Phone: 210-383-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1230578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: