Provider Demographics
NPI:1124593306
Name:SADA, JENNIFER CARY (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARY
Last Name:SADA
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 1:1160 LOTT AVE # B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2150
Mailing Address - Country:US
Mailing Address - Phone:305-338-9475
Mailing Address - Fax:
Practice Address - Street 1:11300 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-2665
Practice Address - Country:US
Practice Address - Phone:128-356-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143415363LF0000X
FLARNP9372859363LF0000X
TXAP143415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily