Provider Demographics
NPI:1639861602
Name:CAINE JACOBS, LORETTA DENISE
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:DENISE
Last Name:CAINE JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:DENISE
Other - Last Name:CAINE JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COMM HEALTH WORKER
Mailing Address - Street 1:3604 SW 31ST DR APT 20D
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2655
Mailing Address - Country:US
Mailing Address - Phone:135-221-9982
Mailing Address - Fax:
Practice Address - Street 1:3604 SW 31ST DR APT 20D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2655
Practice Address - Country:US
Practice Address - Phone:135-221-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker