Provider Demographics
NPI:1922208933
Name:JACOBE-MANN, CRISTA A (RPT)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:A
Last Name:JACOBE-MANN
Suffix:
Gender:F
Credentials:RPT
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 8940
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89507-8940
Mailing Address - Country:US
Mailing Address - Phone:775-784-1999
Mailing Address - Fax:
Practice Address - Street 1:900 N VIRGINIA ST
Practice Address - Street 2:SPORTSMEDICINCE COMPLEX
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89507
Practice Address - Country:US
Practice Address - Phone:775-784-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist