Provider Demographics
NPI:1760209480
Name:SHORE, SARAH ENSTROM (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ENSTROM
Last Name:SHORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 1947
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-0001
Mailing Address - Country:US
Mailing Address - Phone:601-292-4562
Mailing Address - Fax:
Practice Address - Street 1:501 MARSHALL ST STE G07
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-968-3238
Practice Address - Fax:601-968-3237
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS894502363LF0000X
MS906746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily