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General NPI Number Information
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NPI Number | 1821675745
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Entity Type | Individual
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Provider Name | SARA JACOB APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 4425 PLANO PKWY STE 203
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City | CARROLLTON
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State | TX
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Zip | 75010-5026
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Country | US
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Telephone | 972-752-6206
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Fax | 972-695-8792
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Provider Business Mailing Address
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Address Line | 809 GRAYSTONE DR
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City | GARLAND
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State | TX
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Zip | 75043-3717
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Country | US
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Telephone | 469-274-2417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1011829
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License Number State | TX
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