Provider Demographics
NPI:1790069425
Name:JACOB, JOYCE A (SCHOOL NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:A
Last Name:JACOB
Suffix:
Gender:F
Credentials:SCHOOL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 CANAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6121
Mailing Address - Country:US
Mailing Address - Phone:626-333-5155
Mailing Address - Fax:
Practice Address - Street 1:3204 CANAL POINT DR
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6121
Practice Address - Country:US
Practice Address - Phone:626-333-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129068163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDT35626OtherSCHOOL NURSE