Provider Demographics
NPI:1821675745
Name:JACOB, SARA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3717
Mailing Address - Country:US
Mailing Address - Phone:469-274-2417
Mailing Address - Fax:
Practice Address - Street 1:4425 PLANO PKWY STE 203
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-5026
Practice Address - Country:US
Practice Address - Phone:972-752-6206
Practice Address - Fax:972-695-8792
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011829363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care