Provider Demographics
NPI:1124417142
Name:JACOBY, VICTORIA (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 AUGUST FERN LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2806
Mailing Address - Country:US
Mailing Address - Phone:870-278-7359
Mailing Address - Fax:870-408-4059
Practice Address - Street 1:239 AUGUST FERN LOOP
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2806
Practice Address - Country:US
Practice Address - Phone:870-278-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004275363LF0000X
FL11011098363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health