Provider Demographics
NPI:1619313202
Name:JACOBS, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WEST ILLINOIS AVENUE
Mailing Address - Street 2:ATTN: APRIL SMITH
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-692-2444
Mailing Address - Fax:910-692-3031
Practice Address - Street 1:195 WEST ILLINOIS AVENUE
Practice Address - Street 2:ATTN: APRIL SMITH
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-692-2444
Practice Address - Fax:910-692-3031
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-024522084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry