Provider Demographics
NPI:1578116927
Name:JACOBS, PAMELA JOANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9522
Mailing Address - Country:US
Mailing Address - Phone:716-628-8222
Mailing Address - Fax:
Practice Address - Street 1:77 WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9522
Practice Address - Country:US
Practice Address - Phone:716-628-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344542-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF344542-01OtherNYS
NY476208-1OtherNEW YORK STATE