Provider Demographics
NPI:1134319908
Name:JACOBS, JANUS LONG (FNP)
Entity Type:Individual
Prefix:
First Name:JANUS
Middle Name:LONG
Last Name:JACOBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANUS
Other - Middle Name:LONG
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:601 N INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5234
Mailing Address - Country:US
Mailing Address - Phone:817-283-0161
Mailing Address - Fax:
Practice Address - Street 1:601 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5234
Practice Address - Country:US
Practice Address - Phone:817-283-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117194363LF0000X
TN000086938363LF0000X
TNAPN0000006514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39043961Medicare PIN