Provider Demographics
NPI:1558565903
Name:SACKS, JODI LEE (RN ANP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:SACKS
Suffix:
Gender:F
Credentials:RN ANP
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Mailing Address - Street 1:15202 FALL PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3226
Mailing Address - Country:US
Mailing Address - Phone:210-499-4848
Mailing Address - Fax:
Practice Address - Street 1:4241 WOODCOCK DR
Practice Address - Street 2:SUITE A-100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1328
Practice Address - Country:US
Practice Address - Phone:210-785-5255
Practice Address - Fax:210-785-5389
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX722046363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F20594Medicare PIN