MEDICARE: SARA BETH ELLISOR FNP

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	AP135774	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518470830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BETH ELLISOR FNP

Provider Business Mailing Address
First Line	:	61 HARDY LN
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-1872
Country	:	US
Telephone Number	:	936-537-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 INTERSTATE 45 S STE 2B
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-5649
Country	:	US
Telephone Number	:	936-436-9098
Fax Number	:	936-439-9098

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

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	10/27/2022

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