Provider Demographics
NPI:1497344279
Name:SANDERS, JARED MICHAEL (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:MICHAEL
Last Name:SANDERS
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:MR
Other - First Name:JARED
Other - Middle Name:
Other - Last Name:SEAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNPC-AG
Mailing Address - Street 1:300 BRETZ CT STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8615
Mailing Address - Country:US
Mailing Address - Phone:717-567-3174
Mailing Address - Fax:717-703-0018
Practice Address - Street 1:300 BRETZ CT STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8615
Practice Address - Country:US
Practice Address - Phone:717-567-3174
Practice Address - Fax:717-703-0018
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023431363LA2100X, 363LC0200X, 363LG0600X
MO2021005462363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine