Provider Demographics
NPI:1255009486
Name:JACOBS, NATHAN (NP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4365
Mailing Address - Country:US
Mailing Address - Phone:513-924-8900
Mailing Address - Fax:
Practice Address - Street 1:8000 5 MILE RD STE 260
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4365
Practice Address - Country:US
Practice Address - Phone:513-924-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015130363LF0000X
OHAPRN.CNP.0035789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily