Provider Demographics
NPI:1750497533
Name:JACOBS, JENNIFER J (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862565
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2565
Mailing Address - Country:US
Mailing Address - Phone:800-248-1639
Mailing Address - Fax:
Practice Address - Street 1:501 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1419
Practice Address - Country:US
Practice Address - Phone:561-362-4400
Practice Address - Fax:561-362-4445
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3259022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered