| Doctor Name: | MS. JACQUELINE SANNER |
| NPI Number: | 1104123074 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP-BC |
| License Number: | 441081 |
| Business Practice Address: | 190 Buttercup Crk Cedar Park, TX - 786133772 |
| Business Phone Number: | 5123365824 |
| Business Fax Number: | 5123365293 |
| Mailing Address: | Po Box 189, CEDAR PARK |
| State: | TX |
| Postal Code: | 786300189 |
| Phone Number: | 5123365824 |
| Fax Number: | 5123365293 |
| NPI Enumeration Date: | 02/11/2011 |
| NPI Last Update Date: | 02/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 441081 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |