Provider Demographics
NPI:1558513663
Name:JACOB, JAIS MATHEW (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JAIS
Middle Name:MATHEW
Last Name:JACOB
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 CARRINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043
Mailing Address - Country:US
Mailing Address - Phone:469-360-1164
Mailing Address - Fax:972-240-1412
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-1721
Practice Address - Country:US
Practice Address - Phone:972-812-1091
Practice Address - Fax:972-812-1093
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX692194OtherTX LICENSES