Provider Demographics
NPI:1295402030
Name:JACOB, HEATHER HULALI (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:HULALI
Last Name:JACOB
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 E OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2434
Mailing Address - Country:US
Mailing Address - Phone:602-284-1702
Mailing Address - Fax:
Practice Address - Street 1:8655 MARKET ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4112
Practice Address - Country:US
Practice Address - Phone:440-255-6400
Practice Address - Fax:440-255-3637
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily