Provider Demographics
NPI:1578320891
Name:WOODS, JACOB ANTHONY (MSN, PMHNP-BC, APRN)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ANTHONY
Last Name:WOODS
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14073 S CHARDONNAY WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3857
Mailing Address - Country:US
Mailing Address - Phone:315-854-0016
Mailing Address - Fax:
Practice Address - Street 1:688 E VINE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5549
Practice Address - Country:US
Practice Address - Phone:801-436-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9471119-3102163WP0808X
UT9471119-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health