Individual
SARA ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1800 N 12TH ST, READING, PA 19604-3347
(610) 816-5728
(610) 816-5710
Mailing address
1929 LINCOLN HWY E, LANCASTER, PA 17602-3347
(762) 571-7397
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP025637
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104140610-0002
—
PA
01
—
MEDICARE
2L6567
PA
Enumeration date
08/10/2022
Last updated
05/23/2024
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