Provider Demographics
NPI:1851734230
Name:JACOBS, GINA RENEE (OWNER/OPERATOR DOT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:RENEE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OWNER/OPERATOR DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N COLLEGE ST.
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398
Mailing Address - Country:US
Mailing Address - Phone:615-351-7890
Mailing Address - Fax:
Practice Address - Street 1:305 N COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398
Practice Address - Country:US
Practice Address - Phone:615-351-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN003562341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND0697OtherDEPT OF TRANSPORTATION