Provider Demographics
NPI:1043681612
Name:JACOBS, GINNY
Entity Type:Individual
Prefix:MRS
First Name:GINNY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 TRAILWOOD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3530
Mailing Address - Country:US
Mailing Address - Phone:281-793-6998
Mailing Address - Fax:
Practice Address - Street 1:506 GRAHAM DR
Practice Address - Street 2:SUITE190
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3346
Practice Address - Country:US
Practice Address - Phone:281-793-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory