Provider Demographics
NPI:1972014199
Name:JACOBS, MARIA ANNETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANNETTE
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 1:2245 BALSAN WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6435
Mailing Address - Country:US
Mailing Address - Phone:561-385-7843
Mailing Address - Fax:
Practice Address - Street 1:2245 BALSAN WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6435
Practice Address - Country:US
Practice Address - Phone:561-795-7749
Practice Address - Fax:561-795-7749
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9207533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily