MEDICARE: MRS. SARAH R TABOR FNP-C

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	363LF0000X	Family Nurse Practitioner	1017362	TX

General Provider Information

NPI Number	:	1417556341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH R TABOR FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 471109
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76147-1109
Country	:	US
Telephone Number	:	405-808-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4819 EL CAMPO AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4917
Country	:	US
Telephone Number	:	405-808-7272
Fax Number	:

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

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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