Provider Demographics
NPI:1679020275
Name:JACOBS, TAMI LYNN (MASTERS)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:LYNN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 KILLARNEY BEACH RD.
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-284-2220
Mailing Address - Fax:
Practice Address - Street 1:365 KILLARNEY BEACH RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1108
Practice Address - Country:US
Practice Address - Phone:989-284-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other