Provider Demographics
NPI:1679124093
Name:JACOBS, ERICA LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LYNN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-7714
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:315-750-3424
Practice Address - Street 1:138 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-7714
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:315-750-3424
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663276-01163W00000X
NY663276163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse