Provider Demographics
NPI:1275188757
Name:VERGIS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VERGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10453 KEYSBURG CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7785
Mailing Address - Country:US
Mailing Address - Phone:318-820-4230
Mailing Address - Fax:
Practice Address - Street 1:624 I 30 E STE 100
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-7566
Practice Address - Country:US
Practice Address - Phone:972-635-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206921363LF0000X
TX1076029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily