MEDICARE: SARAH NULL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	TEMORARY	TX
2	363A00000X	Physician Assistant	PA06852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA06852	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1194031419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NULL PA

Provider Business Mailing Address
First Line	:	2560 CENTRAL PARK AVE STE 195
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1566
Country	:	US
Telephone Number	:	972-420-1475
Fax Number	:	972-539-8000

Provider Business Practice Location Address
First Line	:	2560 CENTRAL PARK AVE STE 195
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1566
Country	:	US
Telephone Number	:	972-420-1475
Fax Number	:	972-539-8000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	01/10/2019

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Directions to “ SARAH NULL PA” Practice Location

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