Provider Demographics
NPI:1346560273
Name:WILCOX, SARA SUSAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:SUSAN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY BLDG 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7247
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:
Practice Address - Street 1:8911 N CAPITAL OF TEXAS HWY BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7247
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249480363L00000X, 363LF0000X
TXAP118441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346560273Medicaid
TX249480Other363L00000X