Provider Demographics
NPI:1215187679
Name:GIBBONS, SARAH L (CPNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-4204
Mailing Address - Country:US
Mailing Address - Phone:830-876-9870
Mailing Address - Fax:830-876-3661
Practice Address - Street 1:1313 VETERANS AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3724
Practice Address - Country:US
Practice Address - Phone:830-374-4436
Practice Address - Fax:830-374-4437
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578107363LP0200X
TXAP115374363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198469204Medicaid