Provider Demographics
NPI:1497519227
Name:JACOBS, ANNA VICTORIA (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VICTORIA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 NW CARY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8436
Mailing Address - Country:US
Mailing Address - Phone:919-443-2557
Mailing Address - Fax:
Practice Address - Street 1:2018 NEW GARDEN RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2486
Practice Address - Country:US
Practice Address - Phone:336-443-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13543363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant