Provider Demographics
NPI:1780697292
Name:SABIN, JENNIFER (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SABIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:281-565-8808
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-565-8808
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780697292OtherBLUE CROSS BLUE SHIELD
TX8383NDOtherBLUE CROSS BLUE SHIELD
TX192943203Medicaid
TX8Y1492OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX270196YKWUMedicare PIN
TX192943203Medicaid
TX270196YMVQMedicare PIN
TX8Y1492OtherBLUE CROSS BLUE SHIELD OF TEXAS