Individual
MRS. SAMARA JA'NEL JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7858 S OLYMPIA AVE, TULSA, OK 74132-1857
(918) 986-9200
(918) 986-9205
Mailing address
1705 E 19TH ST STE 302, TULSA, OK 74104-5410
(918) 748-7585
(918) 403-6352
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1919
OK
Other
Enumeration date
06/10/2010
Last updated
02/28/2019
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