Provider Demographics
NPI:1710155320
Name:FAULK, SABRINA LEA
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:LEA
Last Name:FAULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:LEA
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 S TWIN CITY HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4245
Mailing Address - Country:US
Mailing Address - Phone:409-727-1414
Mailing Address - Fax:409-727-1449
Practice Address - Street 1:520 S TWIN CITY HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4245
Practice Address - Country:US
Practice Address - Phone:409-727-1414
Practice Address - Fax:409-727-1449
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703407363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health