Provider Demographics
NPI:1235627597
Name:JACOBS, SHOLANDA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:SHOLANDA
Middle Name:MICHELLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHALONDA
Other - Middle Name:MICHELLE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1431 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7841
Mailing Address - Country:US
Mailing Address - Phone:409-540-9418
Mailing Address - Fax:
Practice Address - Street 1:1431 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7841
Practice Address - Country:US
Practice Address - Phone:409-540-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily