Provider Demographics
NPI:1821747585
Name:JACOBS, LAVANESEIA C
Entity Type:Individual
Prefix:
First Name:LAVANESEIA
Middle Name:C
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15704 PONY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1529
Mailing Address - Country:US
Mailing Address - Phone:813-506-9804
Mailing Address - Fax:
Practice Address - Street 1:15704 PONY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1529
Practice Address - Country:US
Practice Address - Phone:813-506-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care