Provider Demographics
NPI:1497780464
Name:JACOBS, MARIA ANZ (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANZ
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:ANZ
Other - Last Name:KALICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:7730 WEST BOYNTON BEACH BLVD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-877-1800
Mailing Address - Fax:561-742-4480
Practice Address - Street 1:7730 WEST BOYNTON BEACH BLVD.
Practice Address - Street 2:SUITE 3
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-877-1800
Practice Address - Fax:561-742-4480
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2517262363L00000X
GARN230675363LF0000X
FL11013916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2517262OtherSTATE LICENSE
GA230675OtherGEORGIA STATE LICENSE