Provider Demographics
NPI:1962287102
Name:JACKSON, SABRINAH AZRIEL (MSN,APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SABRINAH
Middle Name:AZRIEL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN,APRN, PMHNP-BC
Other - Prefix:
Other - First Name:SABRINAH
Other - Middle Name:
Other - Last Name:JACKSON-CONTRERAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN,APRN, PMHNP-BC
Mailing Address - Street 1:318 EMERALD ACRES
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2517
Mailing Address - Country:US
Mailing Address - Phone:915-494-7027
Mailing Address - Fax:
Practice Address - Street 1:725 S MESA HILLS DR STE 1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5568
Practice Address - Country:US
Practice Address - Phone:915-887-3410
Practice Address - Fax:833-429-7758
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133181363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health