Provider Demographics
NPI:1376564542
Name:JAKOB, CARA L (MD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:JAKOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120550
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-5389
Mailing Address - Country:US
Mailing Address - Phone:352-394-4237
Mailing Address - Fax:352-394-6097
Practice Address - Street 1:3115 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6880
Practice Address - Country:US
Practice Address - Phone:352-394-4237
Practice Address - Fax:352-394-6097
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258421200Medicaid
G76028Medicare UPIN
43529UMedicare PIN