Provider Demographics
NPI:1518325497
Name:JENNINGS, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JENNINGS
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 1:63 THOMAS JOHNSON DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4396
Mailing Address - Country:US
Mailing Address - Phone:301-698-2424
Mailing Address - Fax:301-698-1018
Practice Address - Street 1:63 THOMAS JOHNSON DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4396
Practice Address - Country:US
Practice Address - Phone:301-698-2424
Practice Address - Fax:301-698-1018
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner