Provider Demographics
NPI:1336680461
Name:JACOB, RACHEL THOMAS (NP-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:THOMAS
Last Name:JACOB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RACHAL
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13606 N 59TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1271
Mailing Address - Country:US
Mailing Address - Phone:602-978-6100
Mailing Address - Fax:602-978-6555
Practice Address - Street 1:13606 N 59TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1271
Practice Address - Country:US
Practice Address - Phone:602-978-6100
Practice Address - Fax:602-978-6555
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily