Provider Demographics
NPI:1053568014
Name:OTT, SARAH J (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:OTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10260 N CENTRAL EXPY
Mailing Address - Street 2:STE 100N
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3437
Mailing Address - Country:US
Mailing Address - Phone:940-565-9118
Mailing Address - Fax:940-383-2512
Practice Address - Street 1:1614 SCRIPTURE ST STE 8
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3838
Practice Address - Country:US
Practice Address - Phone:940-565-9118
Practice Address - Fax:940-383-2512
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002688363LF0000X
TXAP124889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200910430Medicaid
IN000000578797OtherANTHEM
IN177280A4Medicare PIN
IN000000578797OtherANTHEM
INM400058510Medicare PIN