Provider Demographics
NPI:1558620666
Name:JACOBS, JENNIFER JANIECE (LPN06)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANIECE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPN06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 STAUNTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2236
Mailing Address - Country:US
Mailing Address - Phone:216-482-7390
Mailing Address - Fax:
Practice Address - Street 1:1897 STAUNTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2236
Practice Address - Country:US
Practice Address - Phone:216-482-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147338164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse