Provider Demographics
NPI:1770039646
Name:LUCERO-JACKSON, SABRINA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE
Last Name:LUCERO-JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:520-730-6411
Mailing Address - Fax:
Practice Address - Street 1:8263 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5217
Practice Address - Country:US
Practice Address - Phone:520-730-6411
Practice Address - Fax:520-298-3787
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8784363LA2100X
NMCNP-03024363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care