Provider Demographics
NPI:1942608211
Name:JACOBS, HEIDI ROBIN (ARNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ROBIN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SUMMER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2004
Mailing Address - Country:US
Mailing Address - Phone:407-461-8355
Mailing Address - Fax:
Practice Address - Street 1:808 SUMMER OAKS RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2004
Practice Address - Country:US
Practice Address - Phone:407-461-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3039322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily