Provider Demographics
NPI:1154447852
Name:SANDERS, JESSICA CAMILLE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAMILLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 WONDER WORLD DR STE 4301
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7695
Mailing Address - Country:US
Mailing Address - Phone:512-353-6400
Mailing Address - Fax:512-353-3039
Practice Address - Street 1:1340 WONDER WORLD DR STE 4301
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7695
Practice Address - Country:US
Practice Address - Phone:512-353-6400
Practice Address - Fax:512-353-3039
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01594328OtherRR MEDICARE
273820YMG2OtherMEDICARE
TX148010508Medicaid
273820YMG2Medicare PIN
TX8D6716Medicare PIN