Provider Demographics
NPI:1851756308
Name:BURGESS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BURGESS
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 1:1524 S IH 35 FRONTAGE RD
Mailing Address - Street 2:202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4520
Mailing Address - Country:US
Mailing Address - Phone:512-707-1629
Mailing Address - Fax:
Practice Address - Street 1:1524 S IH 35 FRONTAGE RD
Practice Address - Street 2:202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4520
Practice Address - Country:US
Practice Address - Phone:512-707-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant