Provider Demographics
NPI:1124014089
Name:MICHAEL, SARA C (ARNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 WESTERN PL STE 800
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4679
Mailing Address - Country:US
Mailing Address - Phone:877-868-4827
Mailing Address - Fax:
Practice Address - Street 1:6100 WESTERN PL STE 800
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4679
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118899363LA2100X, 363LA2100X
TX783081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318680102Medicaid
KS200353600AMedicaid
TX318680102Medicaid
KS161570Medicare PIN
KS200353600AMedicaid