Provider Demographics
NPI:1912475344
Name:TELLO, SARA VIVIAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:VIVIAN
Last Name:TELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4512 93RD DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5114
Mailing Address - Country:US
Mailing Address - Phone:806-928-1144
Mailing Address - Fax:806-771-9009
Practice Address - Street 1:4407 6TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4733
Practice Address - Country:US
Practice Address - Phone:806-771-5864
Practice Address - Fax:806-771-9009
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP139612207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine