Provider Demographics
NPI:1467563346
Name:JACOBS, MARGARET M (APRN, BC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:207 FLETCHER
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1050
Mailing Address - Country:US
Mailing Address - Phone:734-763-6924
Mailing Address - Fax:734-647-3071
Practice Address - Street 1:207 FLETCHER
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-763-6924
Practice Address - Fax:734-647-3071
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106780363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008602560OtherBCBS
P75798Medicare UPIN
MION56780005Medicare ID - Type Unspecified