Provider Demographics
NPI:1912381989
Name:JACOBS, CHRISTINA (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BROADWAY STE 1800
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1652
Mailing Address - Country:US
Mailing Address - Phone:917-543-4249
Mailing Address - Fax:724-264-3516
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1652
Practice Address - Country:US
Practice Address - Phone:917-543-4249
Practice Address - Fax:724-264-3516
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17485400163W00000X
NY686457163W00000X
NY402089363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse