Provider Demographics
NPI:1598549701
Name:FIJAL, JACOB ANDREW (RN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ANDREW
Last Name:FIJAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-6020
Mailing Address - Country:US
Mailing Address - Phone:520-668-1462
Mailing Address - Fax:
Practice Address - Street 1:6131 E 26TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6020
Practice Address - Country:US
Practice Address - Phone:520-668-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN211449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty