Provider Demographics
NPI:1255693107
Name:JACOBS, DEBRA A (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 BLUESTREAM CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7500
Mailing Address - Country:US
Mailing Address - Phone:937-432-0711
Mailing Address - Fax:
Practice Address - Street 1:2034 BLUESTREAM CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-7500
Practice Address - Country:US
Practice Address - Phone:937-432-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13335-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics